Importance: The recovery model in mental health involves person-driven care and informed decision making to enhance engagement in meaningful activities and inclusion in society. To facilitate the recovery process, occupational therapy practitioners must support their clients in understanding how their participation in meaningful occupation is intimately related to their health and well-being. Objective: To explore whether engaging in an occupational reflection intervention on an inpatient psychiatric unit can support the recovery of adults living with serious mental illness (SMI). Design: Using a phenomenological design, we conducted semistructured interviews to assess whether participation in an occupational reflection intervention supported recovery. Setting: An inpatient psychiatric unit at a university medical center. Participants: We recruited 10 adults living with SMI using purposive sampling. Intervention: Participants engaged in a structured occupational reflection intervention using the Occupational Experience Profile (OEP). The OEP is a time-use diary that captures respondents’ subjective experiences of pleasure, productivity, restoration, and connection in relation to their participation in occupations over 24 hr. Study participants engaged in collaborative analyses regarding their OEP results to explore their subjective experiences in relation to their occupational participation. Outcomes and Measures: Participant self-report during interviews. Results: Engaging in structured reflection affected participants’ experiences of recovery by promoting insight into and awareness of how occupations affect mental health, encouraging positive reframing of occupational experience, and facilitating identification of strategies to support recovery and meaningful participation after discharge. Conclusions and Relevance: Occupational reflection can promote the recovery of adults living with SMI. What This Article Adds: A structured occupational reflection intervention can help adults living with SMI in inpatient psychiatric units to understand the close relationship between their participation in occupations and their health. This process provides valuable insight to clients regarding how to support their recovery through engagement in meaningful occupation.

Date Presented 04/19/21 OT is a treatment for acute psychiatric hospitalization in Taiwan, providing purposeful activities for patients with severe mental illness based on the Model of Human Occupation (MOHO) and the OT Practice Framework. Through in-depth interviews with staff, three key themes of OT services were identified: OT service challenges with MOHO, communication experience of OT services with team members, and a comprehensive index and continuity of treatment effects. Primary Author and Speaker: Shu-Chun Lee Additional Authors and Speakers: Yi-Ching Wu Contributing Authors: David Leland Roberts, Kuang-Pei Tseng, and Wen-Yin Chen

Date Presented 04/19/21 The Let's Get Organized (LGO) group intervention is a promising tool for improving time management and organizational skills. The aim of this study was to describe the experiences and meaning of attending the LGO intervention. Participants described a roller-coaster process toward control in daily life where success and setback were mixed. Most participants experienced meaningful and positive changes in daily life, such as getting more things done and increased control and safety. Primary Author and Speaker: Kajsa Lidstroem Holmqvist Additional Authors and Speakers: Amy Abbott, Vanessa Jewell, Julia Shin, and Marion Russell

PURPOSE. Sensory approaches to mental illness are increasingly prominent in occupational therapy. Despite indicators of efficacy, a paucity of literature supports these approaches. This article provides a scoping review of research on the relationship between sensory processing and mental illness. METHOD. Using Arksey and O’Malley’s (2005) framework, we mapped this area of research and identified gaps in the knowledge base. We searched PubMed, CINAHL Plus, PsycINFO, OTseeker, and the Cochrane Library using the terms sensory and mental health. RESULTS. We found a growing body of neuroscientific research, primarily using electroencephalography and functional MRI, that links atypical neurosensory activity to mental illness. The occupational therapy literature has primarily focused on the efficacy of sensory rooms in psychiatric inpatient settings. CONCLUSION. Research on the efficacy of sensory approaches needs to be expanded, including on how atypical sensory processing in adults with mental illness affects meaningful occupational participation.

As the number of therapists in mental health settings continues to decline, research is needed to explore the scope, satisfaction, and efficacy of services. In this study, we used Patton’s (1997) Utilization-Focused Program Evaluation to explore scope of services, therapist and client satisfaction, and perceived efficacy of services in a free-standing community-based mental health occupational therapy clinic. Surveys were administered to 36 clients and 9 therapists and followed up by qualitative interviews with 6 therapists. We identified characteristics unique to a free-standing psychiatric occupational therapy clinic, along with factors contributing to satisfaction and perceived efficacy of services. The importance of a supportive therapeutic environment and emphasis on the therapist–client relationship were cited as key factors influencing both satisfaction and effectiveness of service. Results are presented and compared with the existing literature.

OBJECTIVE. This study assessed the effectiveness of a supported education program for adults with psychiatric disabilities. METHOD. Thirty-eight adults with psychiatric disabilities were randomly assigned to an experimental group (n = 21) that received supported education services or to a control group (n = 17) that received treatment as usual. RESULTS. We found a statistically significant difference between experimental and control group participant scores on the five instruments used to measure the program's effectiveness. Sixteen of the 21 experimental group participants (76%) completed the program. At 6-month follow-up, 10 (63%) had enrolled in an educational program, had obtained employment, or were applying to a specific program. Only 1 of the control group participants was enrolled in an educational program. CONCLUSION. The results support the effectiveness of the supported education program. A significant number of participants were able to improve their basic academic skills, enhance professional behaviors and social skills, and return to the school or work environment.

Objective. This study examined the effect of three occupations-based interventions for reducing the frequency of dysfunctional behaviors (disruptive vocalizations, distraction of others, withdrawal from appropriate social interactions) in two women with dual (i.e., developmental, psychiatric) conditions. Additionally, the duration of time spent appropriately engaged was examined. Method. A single-subject, multiple baseline, across-subjects design, with two dually diagnosed residents in a Community Living Arrangement (CLA), was used to evaluate change in four behaviors under three alternating conditions. Condition 1 was CLA (morning and evening combined) compared with the school and sheltered workshop, Condition 2 was CLA morning, and Condition 3 was CLA evening. Intervention consisted of engagement in everyday occupations associated with the school–workshop and CLA settings as well as a positive reinforcement program. Results. Using occupations-based interventions and a behavior modification program, 5 of 6 behaviors improved significantly in the school-and-workshop setting compared to the CLA, under Condition 1. Under Condition 2, the morning occupations-based intervention in conjunction with positive reinforcement for active participation significantly improved 4 of 6 behaviors for the two residents. Similarly, under Condition 3—the evening occupations-based intervention—4 of the 6 targeted behaviors improved significantly. Conclusion. The use of everyday occupations as interventions, in conjunction with positive reinforcement for active participation, was effective for decreasing dysfunctional behaviors and increasing functional behaviors in two women with dual conditions who resided in a CLA.

Objective. This study examined the relationship of the Allen Cognitive Level Test (ACL) to demographics, diagnosis, and disposition after hospitalization among persons with psychiatric disorders. Method. Data were retrospectively collected from medical records, including initial occupational therapy evaluation notes, on 62 female and 38 male patients consecutively admitted to an urban, acute psychiatric inpatient unit. Collected was information on demographics, diagnosis, mental and physical health history, initial ACL scores, role involvement, and discharge living situation (DLS). Results. Patients with higher initial ACL scores were more likely to be younger, to have lived independently before admission, to have been given nonpsychotic diagnoses, and to have been suicidal before admission. Although DLS was most strongly correlated with Living situation before admission, ACL scores showed the second strongest correlation to DLS. Patients with higher ACL scores were significantly more likely to be discharged to independent living than were patients with Lower ACL scores. Conclusions. These results provide evidence that patients’ cognitive Level, as measured by the ACL, may be a useful predictor of community functioning. However, further research is needed to validate the Cognitive Disabilities Model.

Objective. This ethnographic study examined what makes work meaningful for persons with persistent mental illness and how this meaningfulness relates to their recovery. Method. Twelve persons between 32 and 58 years of age who had been involved an average of 19 years with a formal mental health system participated in in-depth interviews and a focus group. Thematic analysis and case studies were understood in the context of the investigator’s 15 months of participant observation of 35 persons with psychiatric disabilities working at an affirmative business. Results. The meaning of work varied with participants ’perception of their illness and their self-concept. Changes in their self-efficacy and self-concept were driven by their participation in work activities to operate the affirmative business. Conclusion. Findings suggest that therapists could potentially facilitate these changes in clients’ sense of self-efficacy and self-concept by helping them make connections with meaningful occupations and contributions to organizations in the community and to experience challenges and successes in the context of meaningful work.

Objective. We designed a simple rating instrument, the Occupational Therapy Task Observation Scale (OTTOS)^©, to facilitate evaluation and documentation of patient performance during occupational therapy task groups and to improve the communication between occupational therapists and other treatment team members. Method. After analysis of other rating instruments, a preliminary version of OTTOS was designed, extensively field tested, and further modified. Interrater reliability was determined, and validity was tested against three established rating instruments: the Bay Area Functional Performance Evaluation, the Comprehensive Occupational Therapy Evaluation Scale, and the Milwaukee Evaluation of Daily Living Skills. Results. The final version of OTTOS contains two parts, 10 items for evaluation of specific task functions and 5 items for rating general behavior. Field use demonstrated that the scale successfully tracked changes in functional capacity and included most facets of patient function evaluated during task groups. Use of OTTOS required minimal training, and scoring required less than 2 min for each patient. The correlation between the scores of experienced occupational therapists was high (.92 for the total scores). The correlation between OTTOS and the other rating instruments ranged from .880 to .340; the highest correlations, as expected, were with test subscales that most closely resembled OTTOS. Conclusion. Preliminary data indicated that OTTOS offers a reliable and valid method for rapidly rating the function of patients with psychiatric illness attending task groups. In addition, use of OTTOS improved the communication between occupational therapists and other health care providers, facilitated the education of occupational therapy students, and met the documentation requirements of third-party payers.

Objectives. The purpose of this study was to investigate the relationship between cognitive disability and social skills in an acute care adult inpatient psychiatric population (n = 55). Method. Independent ratings of patient’s social skills were made during a semistructured interview using the Social Interaction Test (SIT), followed by measurement of cognitive disability using the revised Allen Cognitive Level Test (ACL-90). Reliability of the assessments was established. Results. Significant correlations were found between the ACL-90 and SIT scores: patients with greater cognitive disability had poorer social skills. ACL-90 scores were not related to gender or diagnosis. A gender difference was found for SIT scores with women having better social skills than men. Conclusion. These findings suggest there is a relationship between cognitive disability and social skills in adult psychiatric inpatients. Implications for occupational therapy treatment include better integration of the grading of the cognitive and social requirements of tasks to achieve optimal functioning.

Before 1970, most assessments administered by occupational therapists were informal and nonstandardized. Since the 1970s, the use of scientifically sound instruments has increased. One such standardized assessment, the Bay Area Functional Performance Evaluation (BaFPE), was developed to measure the functional performance of psychiatric clients. This study was designed to explore the use of a revised version of BaFPE as an example of standardized assessment in occupational therapy. The BaFPE was selected as an example of an assessment extensively used in psychiatric occupational therapy practice. A qualitative study that used in depth semistructured interviews was conducted with a convenience sample of occupational therapists. The occupational therapists who were interviewed described and explained making several adaptations and modifications to the recommended administration and scoring of the BaFPE. An analysis of the interview data suggested that standardized assessments are valued as indicators of professional status. However, the interview responses also suggested that the demands of test standardization were incongruent with the values that guide occupational therapy practice. The findings of this study suggest that the future development and use of standardized instruments should be consistent with the values of the profession. In particular, assessments that recognize the diverse nature and needs of individual clients are required.

The purpose of this study was to compare the use of crafts in psychiatric occupational therapy practice with the actual craft-related training received by occupational therapy students. Two questionnaires were developed, one related to the crafts used in clinical practice, the other related to the amount and type of craft training received in educational programs. One thousand occupational therapists who work in psychiatry and 139 accredited and developing educational programs were asked to complete the questionnaire appropriate to their setting. The final analysis involved 121 educational programs (87% response rate) and 384 clinical programs (38% response rate). The results suggest that there may be substantial differences between craft related training and actual clinical use of crafts. The findings imply that educational programs must reevaluate the types of crafts taught and the method by which they are integrated into the total curriculum. Implications for the profession include the need to clarify the role of crafts as a therapeutic modality and to reflect on the future direction of the profession.

This article discusses some of the challenges that occupational therapists working in acute psychiatric inpatient settings commonly face. There is often a lack of sufficient time available for treatment as well as limitations inherent in addressing functional problems in the artificiality of a hospital environment. A theoretical framework is introduced from which the role of occupational therapy and realistic objectives for acute short-term care can be identified. This framework for inpatient occupational therapy practice is based on the concept of activities health, which provides a definition of health in functional rather than medical terms. The importance of emphasizing the patient’s competence in roles assumed in community living is emphasized. A step-by-step approach to program development with specific examples is also provided.