Occupational therapists' experience of working with immigrant clients in mental health care

Abstract

Sweden's cultural diversity generates considerable challenges for occupational therapists. The aim of this study was to explore experiences and perceptions of occupational therapists working with immigrant psychiatric clients from the Middle East region. The study included interviews with eight occupational therapists employed in mental health care and working in a variety of settings. The data collection and analysis were carried out in accordance with the grounded theory approach. One core category, “the challenges of the multicultural therapeutic journey—a journey on a winding road” was identified. The core category included three categories: dilemmas in clinical practice, feelings and thoughts, and building cultural bridges, in turn comprising sub-categories and components. The results showed that the many dilemmas influencing effective multicultural occupational therapy were cultural, societal, and professional in nature. The dilemmas influenced feelings and thoughts, in turn influencing both motivation for seeking cultural knowledge and choice of adequate strategies in which the multicultural therapeutic relationship could develop. The results imply that culturally congruent occupational therapy practice needs to be further developed and more research is needed on how cultural issues can be met in occupational therapy practice.     

Exploring Arising Moments and Mindfulness in Occupational Therapists Working in Diverse Clinical Practice Areas

ABSTRACT

An online survey was conducted with 72 Canadian occupational therapists to (1) explore if and how occupational therapists were aware of “arising moments” in clinical practice, which are moments that give rise to emotions, sensations, and thoughts, and (2) to examine therapists’ responses to questions related to mindfulness. Participants described arising moments through an open-ended survey question. Framework analysis was used to develop key themes and subthemes. A modified Philadelphia Mindfulness Awareness (PHLMS) subscale with two additional survey questions “understanding of living in the moment and being present, and awareness of mindfulness” (sum = PAM) were used as indicators of mindfulness. There were significant differences in the means of PHLMS mindfulness among therapists working in diverse practice areas (F = 3.63, p = .009). Posthoc analysis revealed that therapists working in mental health had higher mean PHLMS-mindfulness scores than in all other groups. There were no significant differences in PAM mindfulness among the practice areas (ANOVA, F = 2.15, p = .08). However, posthoc tests showed that the participants in the mental health practice area had a significant difference with one group, general physical health. Findings have implications for practice in occupational therapy and education about mindfulness in occupational therapy.     

Collaborative Learning Applied to Fieldwork Education

SUMMARY

Occupational therapists of the 21st century must be educated to provide intervention within health, education, community, and policy-making areas. Therapists need to solve complex problems, often in collaboration with numerous stakeholders. This article proposes that preparing occupational therapists for current practice requires a fundamental change in our educational beliefs and that a collaborative approach among students and fieldwork educators is most congruent with the interactive environments of current practice. The philosophical principles of collaborative learning are reviewed and practical considerations to apply the principles to Level II fieldwork programs are described.     

The myth of participation in occupational therapy: reconceptualizing a client-centred approach

Abstract

Participation is often the comprehensive objective of treatment but also an indication of the extent to which the process of occupational therapy is client-centred. The purpose of this study was to explore levels of participation during occupational therapy among clients in the area of mental health from the occupational therapists' perspectives. Additionally the authors sought to identify factors that might hinder client participation. Postal questionnaires were sent out to 670 Swedish occupational therapists working with persons with mental illness and learning disabilities. The questionnaire required therapists to rate clients' levels of participation during occupational therapy. Findings indicated that the most common level of participation for the clients was interdependent, meaning that problems, goals, and plans were identified jointly and collaboratively with the occupational therapist. However, more than 20% of the clients were described as being dependent. Almost 90% of the occupational therapists rated client participation in therapy to be very important and nearly 70% claimed that client participation in general needed to be increased. Occupational therapists rated the primary barriers to participation as being clients' inability to participate and organizational and financial problems. Implications of these findings for education in client-centred practice approaches are discussed.     

Consultation:

In order to survive and grow as a viable mental health care profession, occupational therapists must learn new ways of providing service. One such way is using consultation theory and techniques. This article reviews pertinent literature about consultation and summarizes Caplan's classification for use by occupational therapists who are, or are considering, working in community-based service delivery systems such as mental health centers. The article can be used by those needing basic knowledge as well as by those seeking resources for further information.     

New Doors: A Community Program Development Model

SUMMARY

The need to provide occupational therapy services across a continuum of care has stimulated interest in moving into community-based arenas of practice. Limited job opportunities and lack of awareness of the benefits of occupational therapy are common barriers to this movement. This case study illustrates the “New Doors Model” and describes how a partnership between the university, master clinicians, students, and community agencies can result in (1) expanding occupational therapy services to facilities that have not historically interacted with occupational therapy, (2) training occupational therapists and occupational therapy students, and (3) promoting employment of occupational therapists by community organizations, and (4) a scholarship of practice that studies and supports the development of occupation based practice in community settings. The New Doors Model begins with exposing new sites to occupational therapy through level I fieldwork, progressing to level II fieldwork, and ending with creation of permanent occupational therapy positions     

The Reindeer of Hope: An Occupational Therapy Program in a Homeless Shelter

SUMMARY

This article describes a successfully designed and implemented program created for mentally ill homeless men by Level II occupational therapy students from Eastern Kentucky University. Outcomes for the clients, the staff and the students were extremely positive and have contributed to the appreciation and acceptance of occupational therapy as a discipline that can contribute to the health of this underserved population. This model demonstrates the effectiveness of University sponsored fieldwork in introducing occupational therapy to the community, creating awareness of what occupational therapy has to offer and developing a climate to bring needed services to clients and provide community-based employment for occupational therapists.     

The Changing Role of the Social Worker in the Mental Health System

ABSTRACT

The purpose of this paper is to discuss the role of the social work profession in the mental health service arena. It analyzes the changing mental health environment and the challenges facing social work. It stresses that the profession must adapt to the dramatic changes that have been taking place since the advent of deinstitutionalization and the need for community care for mentally ill persons.

Historical analysis of the social work profession shows that its involvement in the mental health field has started during the early stages of the development of the profession. Psychiatric social work has been considered a prestigious area of practice within the profession. Historically, social workers in the mental health field rarely challenged the dominance of the psychiatric profession. This position seems to have restrained social work from providing its full potential contribution to this field of practice and to the population it served.

Assessment of the continuing problems and current issues of the mental health system shows the potential central role of social work in this area. However, changes must take place in the practice of social workers in the mental health service system, as well as in the education and training of social workers. The paper discusses factors that facilitate or hinder the profession from appropriately adapting to the current service needs of the mentally ill persons, their families and communities, providing quality mental health and social services to this population and society as well.     

Service Learning in a Pediatric Weight Management Program to Address Childhood Obesity

ABSTRACT

This paper describes an inter-professional service learning collaboration and reflects benefits and considerations when incorporating a family-oriented approach in the community-based pediatric weight management program. Because obesity has tremendous consequences on a nation's health and economy, a pediatrician in a community health network has utilized an inter-professional team to implement a pediatric weight management program targeting children between the ages of 8 and 15 years. The team incorporates a culturally sensitive curriculum using a family-oriented approach for obesity prevention and intervention. Physicians, registered dietitians, occupational therapists, nurse practitioners, and mental health professionals assist participants in adopting a healthier lifestyle by addressing physical and psychosocial issues related to obesity, developing a nutrition plan, making healthier food choices, and finding fun ways to be more physically active. Graduate occupational therapy students work closely with the team members to assist delivery of interactive activities and behavior intervention.     

Work-related self-efficacy of occupational therapists in mental health

Abstract

Aim: Changes in the mental health field have created new job expectations of occupational therapists (OTs). The present research investigated differences in general self-efficacy (GSE) and work-related self-efficacy (WRSE) between occupational therapists (OTs) working in psychiatric hospitals and OTs working in community-based mental health services. Method: Thirty-four OTs working in psychiatric hospitals and 30 OTs working in community-based settings (n = 60) completed the General Self Efficacy Scale (GSE) and the WRSE in Mental Health Occupational Therapy Scale (WSMOT). Results: The two groups showed no differences in total WRSE score. Both evinced high self-efficacy in direct intervention activities, and low self-efficacy in managing and counseling. Conclusion: Results enlighten an overall high WRSE, which indicates successful adaptation of OTs to changing roles and tasks in mental health, similar to studies in other countries. However, it reveals discrepancies between job demands and self-efficacy of OTs that should be addressed at educational and managerial levels.     

Sharing Stories: Using Narratives to Illustrate the Role of Critical Reflection in Practice with First Australians

This paper aims to fill a gap in existing literature by using examples of reflective practice and how these informed service delivery and development with First Australians within a population health paradigm. Population‐based approaches have been proposed as useful for providing services that reach beyond the individual. They may be particularly helpful in providing a framework for occupational therapists working with First Australians, when modified appropriately. “Healthy Ears” is a statewide ear health programme for First Australians. It is an example of a health promotion programme working to partner with First Australian communities using a community‐driven and strengths‐based approach. The occupational therapy role within this service has been recently established. Collaborative autoethnography was used to produce narrative reflection and discussion between the first and second authors in order to illustrate the role of critical reflection in developing this new occupational therapy service. The narratives presented are based on three main themes, which emerged as important guiding principles; these are core occupational therapy knowledge and skills, partnerships with communities and organizations and cultural safety. Each theme comprises narrative excerpts followed by interpretations based on the literature. The findings from these narratives, whilst limited to a particular context, suggest there is a need for greater professional preparation and support for occupational therapists working cross‐culturally through undergraduate training and professional development opportunities. This paper highlights the usefulness of reflective practice as a tool for developing culturally safe occupational therapy services and emphasizes the importance of relationships with key First Australians as a platform for culturally safe practice. Copyright © 2013 John Wiley & Sons, Ltd.     

The development of the Mental Health Advice Centre in Lewisham Health District

The Mental Health Advice Centre in Lewisham, South East London, represents an innovation in psychiatric service aiming to integrate primary health care with mental health professionals and to provide easy access for patients to psychiatric and psychological help. The Centre has been operating for 3 years and is staffed by a multi-professional team comprising psychiatrists, clinical psychologists, psychotherapists, social workers, community psychiatric nurses, occupational therapists, research workers, and volunteers. This report outlines the development of the Centre and presents the results of two years' evaluative work. Social, demographic, and psychiatric characteristics of the clients who attended the Centre during these two years are described.     

Participatory citizenship: Critical perspectives on client-centred occupational therapy

Abstract

Background/aims: This article aims to discuss client-centred practice, the current dominant approach within occupational therapy, in relation to participatory citizenship. Occupational therapists work within structures and policies that set boundaries on their engagement with clients, while working with complex, multidimensional social realities. Methods: The authors present a critical discussion shaped by their research, including a survey, discussions at workshops at international conferences, and critical engagement with the literature on occupational therapy, occupation, and citizenship. Conclusion: A focus on citizenship suggests reframing professional development based on the participation in public life of people as citizens of their society. While occupational therapists often refer to clients in the context of communities, groups, families, and wider society, the term client-centred practice typically represents a particular view of the individual and may sometimes be too limited in application for a more systemic and societal approach. Significance: The authors question the individual focus which has, until recently, been typical of client-centred occupational therapy. Placing citizenship at the core of intervention is a transformative process that assumes all people are citizens and conceives of health as a collective issue, influencing the way we educate, do research, and practise.     

Examining Intraprofessional Competencies for Occupational Therapist and Occupational Therapy Assistant Collaboration

Abstract

This study examined competencies perceived by occupational therapists and occupational therapy assistants as important for intraprofessional collaboration. While interprofessional practice is well defined, less is known about collaboration within professions with varied levels of practice credentials. Occupational therapy practitioners (N?=?351) rated 20 competencies in four domains (Intraprofessional Teamwork, Roles/Responsibilities, Communication, and Values/Ethics) through an online survey. A high percentage of respondents perceived all competencies as important or very important. There were significant differences between occupational therapists and occupational therapy assistants in ratings of five competencies, including: seeking information/support from the team partner, flexibility for effective partnership, engagement in professional development for collaboration, communicating ideas, and providing feedback about performance. Outcomes contribute to understanding intraprofessional collaboration for occupational therapy practice. Competencies can serve as guidelines for education and professional development.