Evidence for Interventions to Improve and Maintain Occupational Performance and Participation for People With Serious Mental Illness: A Systematic Review

Association of Inpatient Occupational Therapy Utilization With Reduced Risk for Psychiatric Readmission Among Veterans

OBJECTIVE

The authors sought to investigate whether utilization of inpatient occupational therapy (OT) was associated with reduced risk for 30-day psychiatric readmission in the Veterans Health Administration (VHA).

METHODS

The authors conducted a secondary analysis of VHA medical record data for veterans who received inpatient psychiatric care from 2015 to 2020 (N=176,889). Mixed-effects logistic regression was used to model psychiatric readmission within 30 days of discharge (yes or no) as a function of inpatient psychiatric OT utilization (none, one, two, three, or four or more encounters) and other care utilization (e.g., previous psychiatric hospitalization), as well as clinical (e.g., primary diagnosis), sociodemographic (e.g., race-ethnicity), and facility (e.g., complexity) characteristics. Sensitivity analyses were conducted to evaluate the robustness of findings (e.g., stratification by discharge disposition).

RESULTS

Relatively few veterans received inpatient psychiatric OT (26.2%), and 8.4% were readmitted within 30 days. Compared with veterans who did not receive inpatient psychiatric OT, those with one (OR=0.76), two (OR=0.64), three (OR=0.67), or four or more encounters (OR=0.64) were significantly (p<0.001) less likely to be readmitted within 30 days. These findings were consistent across all sensitivity analyses.

CONCLUSIONS

Veterans who received inpatient OT services were less likely to experience psychiatric readmission. A clear dose-response relationship between inpatient psychiatric OT and readmission risk was not identified. These findings suggest that OT services may facilitate high-value inpatient psychiatric care in the VHA by preventing readmissions that stymie recovery and incur high costs. Future research may establish the causality of this relationship, informing policy regarding increased access to inpatient psychiatric OT.

Contributions of a time use perspective in community mental health practice: a scoping review

Introduction

Time use is an important indicator of health and well-being. Exploration of time use can provide in-depth information about individuals' activity patterns including routines and structure, the experience of activities, personal priorities and challenges. People experiencing severe mental illness may be at particular risk for time use patterns associated with poor health and wellbeing.

Methods

This scoping review aimed to identify and map the evidence about how a time use perspective informs assessment and intervention in community mental health practice. Electronic databases and hand-searches were used to identify relevant studies involving people with severe mental illness, and focused on time use applications in practice. Twenty-nine studies were included in this review, data-extracted and synthesized with reference to the review question.

Results

Of the twenty-nine identified studies, seven described development and psychometric testing of time use assessments; twelve used time use tools to measure outcomes; and ten described or evaluated time use intervention approaches. The identified time use assessments typically involved retrospective diaries completed before or during structured interviews, and an Experience Sampling Method using smart technology to gather activity data in real time. Both psychosocial and occupational interventions used time use to measure outcomes relevant to activity engagement, social functioning, and personal recovery. The identified time use interventions originated in occupational therapy; included structured manuals and workbooks to enable reflection on daily time use; individual or group sessions to collaborate in identifying priorities, goal planning and supporting desired changes to activity patterns. These interventions were viewed favorably overall, with improved activity engagement, quality of life, and personal recovery reported.

Discussion

Time use assessments evaluate outcomes of importance to personal recovery and community inclusion. Time use interventions address activity patterns associated with poor health and wellbeing, using collaborative and supported activity engagement approaches, and contribute to emerging evidence on interventions that support personal recovery. Furthering peer involvement in developing and delivering these interventions will bring important insights to time use practice and research, while the social forces that marginalize or constrain activity participation for people with severe mental illness also need to be addressed to advance time use and other approaches that aim to support community inclusion.

Occupational Therapy in Psychiatric Short-Term Hospitalization Units: Scoping Review

Given the context, the overarching aim is to identify scientific publications on occupational therapy in Psychiatric-Short-Term-Hospitalization-Units. Specific objectives include: (a) Analyzing the historical development of this research area; (b) Synthesizing existing evidence on the nature of documentary sources on occupational therapy in in Psychiatric-Short-Term-Hospitalization-Units; (c) Detailing the volume of scientific literature on occupational therapy in these units; (e) Evaluating available evidence on occupational therapy interventions to improve functionality, quality of life, and recovery in individuals admitted to in Psychiatric-Short-Term-Hospitalization-Units. A scoping review method was employed to conduct a historical mapping of research on in Psychiatric-Short-Term-Hospitalization-Units. The review proceeded in five stages following PRISMA guidelines. After applying selection criteria, the search identified 446 references. Findings are presented under three headings: (a) Historical trends in the scientific literature on occupational therapy and in Psychiatric-Short-Term-Hospitalization-Units; (b) Nature and volume of articles included in the occupational therapy synthesis in Psychiatric Short-Term Hospitalization Units; (c) Data extraction on methodological variables in the research of occupational therapy articles in in Psychiatric-Short-Term-Hospitalization-Units; and (d) Data extraction on research outcome variables of occupational therapy articles in Psychiatric Short-Term Hospitalization Units. The growth of occupational therapy in in Psychiatric-Short-Term-Hospitalization-Units is emphasized, with an increase in qualitative studies. Occupational therapy is underscored as an integral part of care, supporting the diversity and effectiveness of interventions. Common diagnoses include schizophrenia and depressive disorders. Group interventions and the spiritual dimension positively influence the quality of care and meaningful routines for recovery in in Psychiatric-Short-Term-Hospitalization-Units.

Occupational Therapy: A Potential Solution to the Behavioral Health Workforce Shortage

Occupational therapy practitioners (OTPs) are clinically prepared to treat patients with behavioral health conditions. Yet, many state and national policies defining qualified behavioral health providers do not include occupational therapy. In this Open Forum, the authors argue that OTPs should be considered qualified to work as behavioral health professionals, especially given the severe behavioral health workforce shortage in the United States. The authors summarize policy barriers preventing OTPs from working on behavioral health teams and the evidence to support their presence. They also propose a policy and advocacy agenda to include and recognize OTPs as members of the behavioral health workforce.

Facility-Level and Racial Disparities in Access to Inpatient Psychiatric Occupational Therapy Services in the Veterans Health Administration

IMPORTANCE

Veterans receiving inpatient psychiatric services with limitations in activities of daily living (ADLs) benefit from occupational therapy, yet disparities in access are unknown.

OBJECTIVE

To investigate whether ADL limitations, an indicator of occupational therapy need, was associated with inpatient psychiatric occupational therapy utilization in the Veterans Health Administration (VHA) and whether this relationship differs by facility characteristics.

DESIGN

Secondary analysis of VHA data. Modified Poisson regression modeled occupational therapy utilization as a function of ADL limitations, facility characteristics, and covariates. Interactions estimated whether the relationship between ADL limitations and occupational therapy utilization differed across facility characteristics.

SETTING

VHA inpatient psychiatric setting.

PARTICIPANTS

Veterans receiving VHA inpatient psychiatric care from 2015 to 2020 (N = 133,844).

OUTCOMES AND MEASURES

Occupational therapy utilization.

RESULTS

Veterans with ADL limitations were more likely to receive occupational therapy. Veterans receiving care in facilities with higher complexity and greater inpatient psychiatric care quality were more likely to receive occupational therapy. Additionally, Black veterans were less likely to receive occupational therapy relative to their White, non-Hispanic counterparts. Interactions indicated that the extent to which ADL limitations drove access to occupational therapy utilization was weaker within facilities with higher complexity and care quality.

CONCLUSIONS AND RELEVANCE

Veterans with ADL limitations were more likely to access inpatient psychiatric occupational therapy, suggesting that such services are generally allocated to veterans in need. However, findings indicate disparities in access across patient-level (e.g., Black race) and facility-level (e.g., facility complexity) factors, informing efforts to eliminate barriers to accessing these valuable services. Plain-Language Summary: This is the first study, to our knowledge, to examine disparities in access to inpatient psychiatric occupational therapy in the Veterans Health Administration (VHA). The study findings show that access to inpatient psychiatric occupational therapy is partly driven by the needs of the patient. However, nonclinical factors, such as a patient's race and the characteristics of the facility at which they receive care (complexity, number of psychiatric beds available, and the quality of psychiatric care), are also important drivers of access. Identifying factors influencing access to these valuable services is the first step in developing strategies that reduce barriers to access for veterans in need.

Changes in pain, daily occupations, lifestyle, and health following an occupational therapy lifestyle intervention: a secondary analysis from a feasibility study in patients with chronic high-impact pain

OBJECTIVES

This study explored changes in pain-related parameters, occupational function, occupational balance, lifestyle factors, and self-perceived health status in adults with chronic high-impact pain participating in an occupational therapy lifestyle intervention.

METHODS

This one-group longitudinal feasibility study was performed in three continuous feasibility rounds. The occupational therapists-led intervention targeted meaningful occupations, regular physical activity, and a healthy diet. The intervention contained individual and group sessions and was added to the standard multidisciplinary chronic pain treatment. Outpatients (n=40, 85 % females, 46.6 ± 10.9 years old) participated in the study between April 2019 and December 2021. The analysis includes data for 31 participants. Analysis of pre-post changes assessed after each feasibility round were performed for the outcomes: pain intensity, pain sensitivity and pain modulation (pressure pain threshold and tolerance, temporal summation of pain and conditioned pain modulation), pain self-efficacy, pain catastrophizing, motor and process skills, occupational balance, daily wake-time movement, daily walking steps, body mass index, waist circumference, blood pressure, and self-perceived health status.

RESULTS

Improvements in motor skills (assessment of motor and process skills score=0.20 (1.37; 1.57), 95 % CI 0.01; 0.38) and temporal summation of pain (-1.19 (2.86; -1.67), 95 % CI -2.16; -0.22), but a decrease in pain tolerance (-7.110 (54.42; 47.32), 95 % CI -13.99; -0.22) were observed. Correlation analysis suggested moderate-to-very strong statistically significant relationships in several outcomes related to pain, health, pain coping, occupational balance, occupational functioning, body anthropometrics, and pain sensitivity.

CONCLUSIONS

This study suggested that the lifestyle intervention would benefit motor skills while effects on other outcomes were unclear in adults with chronic pain. To confirm the findings, a randomized trial evaluating effectiveness is needed. Ethical committee number: SJ-307 Reg. Clinicaltrials.gov: NCT03903900.

Sensory processing, autonomic nervous function, and social participation in people with mental illnesses

Introduction

This study investigated the relationship between sensory processing, respiratory sinus arrhythmia, and social participation in people with psychiatric disorders.

Method

This study recruited 30 participants, primarily women, from a psychiatric university hospital with a mental health diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (mean age: 37.7 ± 16.0 years). Sensory processing, autonomic nervous function, and social participation were measured using the Adolescent/Adult Sensory Profile®, respiratory sinus arrhythmia, and World Health Organization Disability Assessment Schedule, respectively. Through mediation analysis, a model wherein sensory processing mediated the relationship between respiratory sinus arrhythmia and social participation was developed.

Results

Social participation was moderately to highly correlated with Adolescent/Adult Sensory Profile® quadrants (excluding sensory seeking) and respiratory sinus arrhythmia. Furthermore, the mediation analysis revealed that sensory avoiding mediated the relationship between respiratory sinus arrhythmia and social participation, consequently counteracting the direct relationship.

Conclusion

A mediation model was constructed, which indicated that individuals with psychiatric disorders and low parasympathetic nervous system activity expressed higher sensory processing quadrant of sensory avoiding. Ultimately, this was associated with reduced social participation.

Participant Outcomes and Facilitator Experiences Following a Community Living Skills Program for Adult Mental Health Consumers

Outcomes from participating in a six-week small-group living skills program, periodically implemented over two years with twelve adult mental health consumers, are reported as a case study. Occupational therapy and recovery-oriented approaches underpinned the development and implementation of the program thus it was important that outcome measures aligned with these perspectives. Data were gathered pre and post program using the Canadian Occupational Performance Measure (COPM) and the Life Skills Profile-16 (LSP-16) in each iteration of the program. Two occupational therapy program facilitators were interviewed about their experience of running the program and using these measurement tools. COPM occupational performance (p = 0.001) and COPM satisfaction (p = 0.004) scores indicated significant change at post-program whereas the LSP-16 total and subscale scores did not (p = 0.132 for total scores). Facilitator insights into the experience of implementing the living skills program and the perceived alignment of the COPM and LSP-16 with recovery-oriented practice are reported.

Clinical practices, challenges, and job satisfaction of occupational therapists working in Community Mental Health Centers in Turkey

Introduction:

Occupational therapists have been involved in Community Mental Health Centers (CMHCs) since 2016 in Turkey. To the best of our knowledge, no data about occupational therapists’ practices in CMHCs is available in the extant research literature. Therefore, this study aimed to investigate the clinical practices, challenges, and job satisfaction of occupational therapists working for CMHCs in Turkey.

Method:

We conducted a cross-sectional survey study in which 28 volunteer occupational therapists working in CMHCs participated. The participants filled out the Sociodemographic and Professional Experience Information Form and the Job Satisfaction Scale.

Results:

Occupational therapists were experienced practitioners implementing various occupational therapist practices in community mental health and they were generally satisfied with their job. The challenges facing Occupational therapists were communicating with caregivers, motivating the client, enabling the client to perform occupational participation. Collaborative teamwork and participation in training about community mental health were found as the important factors contributing to occupational therapist professionals’ job satisfaction.

Conclusion:

Investigating the professional behaviors of Occupational therapists, an emerging health profession in Turkey, is important for the development of the profession. The education and supervision specially adapted for community mental health and the supportive teamwork seem to be significant for the job satisfaction of community mental health Occupational therapists.

Using Practice-Based Inquiry to Enact Occupation-Centered, Justice-Oriented Practice in an Acute Mental Health Setting

IMPORTANCE

Occupational therapy practitioners working in mental health settings in the United States are faced with challenges and barriers to implementing justice-oriented, occupation-centered practice. Research situated in the practice context with practitioners as coresearchers may provide an avenue for changing practice.

OBJECTIVE

To describe the reconceptualization and redesign of occupational therapy services by a community of occupational therapy practitioners in an acute mental health setting in the United States.

DESIGN

Practice-based inquiry, a form of practitioner-generated action research with a community of practice scholars (CoPS), guided the redesign of practice.

SETTING

Acute mental health service in a large teaching hospital system.

PARTICIPANTS

Nine occupational therapists comprised a CoPS and served as coresearchers and participants in the study.

DATA COLLECTION AND ANALYSIS

Practitioner scholars' experiences of daily practice captured in individual reflections and collective research discussions were the source of data. Data collection, analysis, and action was an iterative process. Coresearchers coded and categorized findings and then developed themes reflecting changes enacted in practice.

FINDINGS

The data analysis resulted in two themes characterizing how the CoPS reconceptualized and redesigned practice to reflect their commitment to occupation-centered and justice-focused occupational therapy: (1) occupational opportunities through direct services and (2) occupational opportunities through system-level change.

CONCLUSIONS AND RELEVANCE

For this CoPS, engaging in a practice-based inquiry facilitated a reconceptualization of their practice and widened their occupational lens, thus strengthening their identity as occupational therapists. Given the barriers to demonstrating occupational therapy's unique contribution to mental health practice, this research provides a valuable tool for practitioners. What This Article Adds: Occupational therapy practitioners who engage in context-specific, action-oriented research experience a transformative process that empowers them to address barriers often encountered in mental health practice and enact occupation-centered and justice-focused practice.

The relationship between psychopathology, occupational balance, and quality of life among people with schizophrenia

OBJECTIVE

There is an increased risk of occupational imbalance and poor quality of life (QoL) if one has schizophrenia. Although evidence suggests a relationship between psychopathology and QoL, the association of occupational balance (OB) with QoL in schizophrenia is unclear. This study aimed to investigate the associations among psychopathology, occupational balance, and QoL in schizophrenia.

METHODS

This was a cross-sectional study carried out in a Community Mental Health Center (CMHC). Ninety-five individuals aged 18 years or older with the diagnosis of schizophrenia participated in the study. All participants completed a sociodemographic form, Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale in Schizophrenia (CDSS), Occupational Balance Questionnaire-11 Turkish Version (OBQ11-T), and the World Health Organisation Quality of Life Assessment Instrument (WHOQOL-100-TR). Relationships among clinical and depressive symptoms, OB, and QoL variables were examined through correlation analysis, and then multiple linear regression analysis was performed to determine the variables that have influences on QOL.

RESULTS

The study participants had low OB scores and the lowest mean in the WHOQOL-social relationships subscale. WHOQOL-overall QoL score demonstrated a moderate negative correlation with the PANSS-total score and PANSS-general psychopathology subscale score (r = -0.422, r = -0.463, P < 0.001) and a mild negative correlation with the CDSS-total score (r = -0.390, P < 0.001). OBQ11-T total score showed a moderate positive correlation with the WHOQOL-overall score (r = 0.549; P < 0.001). Findings from the multiple linear regression analysis revealed that OBQ11-T (β = -0.467, P = 0.000) and PANSS-general psychopathology (β = -0.221, P = 0.045) were significant predictors of the overall QoL, explaining 48% of the variance in the overall QoL (adjusted R²  = .43, P < 0.001).

CONCLUSION

Our study findings showed that OB and general psychopathology are determinants that should be considered in improving the QoL in individuals with schizophrenia. Thereby, addressing the symptoms of general psychopathology and occupational factors to improve the QoL may be achieved with the incorporation of occupation-based programmes to routine treatment. However, further research is required.

Implementation of occupational therapy within early intervention in psychosis services: Results from a national survey

AIM

Occupational therapy plays an important role in fostering community participation in areas such as education, employment, leisure, and social relationships, yet its added value within early intervention in psychosis services, especially in the United States, remains poorly understood. The purpose of this research was to conduct a national survey of early intervention in psychosis programs to: (1) understand the role and unique contributions of occupational therapists to early intervention teams, and (2) identify barriers and supports to the implementation of occupational therapy services within these programs.

METHODS

Fifty-one senior leaders from U.S.-based early intervention in psychosis programs participated in the national survey. The survey consisted of a series of closed and open-ended questions related to program staffing, the presence of specific services that fall within the occupational therapy scope of practice, and implementation barriers and supports.

RESULTS

Despite there being strong interest in employing occupational therapists, a small proportion of programs (31%) reported having them on staff. Occupational therapists supported clients across multiple life areas and were significantly more likely than other team members to promote daily living activities (e.g., cooking) and to address sensory processing needs and challenges. Implementation was influenced by environmental/organizational and staff factors; the primary barrier was funding.

CONCLUSIONS

Findings support the role occupational therapists may play in facilitating the community participation of clients of early intervention services, but significant barriers to implementation of occupational therapy services remain. Additional research is needed to further identify the impact of occupational therapy services within the early intervention model.

A pilot randomized controlled trial of aquatic-based activities in a group occupational therapy program for adults living with serious mental illness in Spain

Although aquatic-based interventions are increasingly used in the psychiatric rehabilitation services, the effects of this type of community program as an adjuvant therapy for psychosocial problems of people with serious mental illness (SMI) have been under-explored. This research evaluated the feasibility and outcomes of an occupational therapy program consisting of aquatic-based activities (AA-OT program) in the community in Spain. This study is the first randomized controlled trial (RCT) on this topic. This pilot trial was conducted with a sample of 16 adults with SMI who were randomly allocated to the AA-OT program plus treatment as usual or treatment as usual alone (eight in each group). The AA-OT program included activation of daily living skills, warm-up, group activities/tasks, and relaxation. It consisted of two sessions per week over 12 weeks. Outcomes were evaluated at week 0 and 12. A total of 14 participants (87.5%) completed the trial. No adverse events or side-effects were noted. Comparisons between the two groups on change scores showed that participants in the intervention group showed significant improvements in several outcome measures: psychosocial problems (HoNOS), two health-related quality of life scales (SF-36: Physical Functioning and Mental Health), and performance of social activities (Activity and Social Relations scale). Satisfaction with the program was high. In conclusion, the results support the feasibility and potential benefits of this occupational therapy program. 12 weeks of aquatic-based activities in a group intervention may enhance the outcomes of psychiatric rehabilitation improving the severity of psychosocial problems, patient-reported health status, and social relations. This community-based program may be beneficial as a non-pharmacologic method in the illness management and recovery of people with SMI. The findings from this pilot trial need to be confirmed in a large, fully-powered RCT.

Appraising Psychiatric Care From a Different Angle: Occupational Therapy Activities and Cardiorespiratory Fitness for Inpatients With Chronic Mental Illness

IMPORTANCE

People with chronic mental illness (CMI) are at high risk of poor cardiorespiratory fitness as a result of sedentary behavior and physical inactivity. Occupational therapy practitioners play a key role as advocates for positive lifestyle change for people with CMI.

OBJECTIVE

To determine the relationships between occupational therapy activities and cardiorespiratory fitness among inpatients with CMI.

DESIGN

This retrospective research included three phases: descriptive cohort, case-control, and cross-sectional studies.

SETTING

Psychiatric inpatient facility.

PARTICIPANTS

Inpatients with CMI, ages 18 to 65 yr (N = 325).

OUTCOMES AND MEASURES

Data were collected over a 12-mo period. Each daily occupational therapy activity performed by participants was converted to energy expenditure (in kcal). Cardiorespiratory fitness was measured by means of the 3-Minute Step Test.

RESULTS

After daily occupational therapy activities, significantly more participants increased cardiorespiratory fitness than declined (McNemar χ2 [1] = 29.18, p < .05). Prevocational activities and moderate- to high-intensity exercises met the optimal energy expenditure level (>352 kcal) necessary to achieve an increase in cardiorespiratory fitness.

CONCLUSIONS AND RELEVANCE

Occupational therapists in psychiatric inpatient settings should prescribe individualized occupation-based or physical activities that meet the optimal daily energy expenditure for each client to improve their cardiorespiratory function. What This Article Adds: This study is one of the first attempts to explore cardiorespiratory fitness outcomes after daily occupational therapy activities for people with CMI. Physical benefits unfolded throughout psychiatric care, echoing the profession's stance on holistic practice.

Practitioners' experiences of deteriorating personal hygiene standards in people living with depression in Australia: A qualitative study

Functional impairment in people diagnosed with depression is common, although the domain of personal hygiene and grooming has received limited attention in the scholarly literature. While issues concerning personal hygiene and grooming by those experiencing depression have been reported in personal narratives, they are rarely included in symptom lists or treatment guidelines, or as an outcome indicator in research studies. The aim of this research was to better understand how mental health practitioners assessed, understood and worked with, service users diagnosed with depression who had previously exhibited declining personal hygiene and grooming standards. In-depth interviews (n = 16) explored the views of professionals experienced in this area of mental health practice. A qualitative descriptive methodology was utilised. Findings indicated that for some service users, personal hygiene and grooming issues were an integral aspect of their depression, which negatively impacted recovery, particularly in areas concerned with overall functioning, mood, social and vocational engagement, motivation, self-worth and esteem, and engagement with treatment. Study results supported the benefits of a person-centred approach to assess, engage with and intervene effectively when a decline in personal hygiene and grooming was noted. However, lack of pertinent research is a barrier to appropriately assessing specific skill or performance difficulties when declining standards are observed. This impedes the provision of interventions which might support the person to develop and maintain of personal hygiene routines, which conform to socially acceptable standards. Difficulties with personal hygiene and grooming presented both a barrier to recovery and an opportunity for timely and salient intervention. Further investigation is needed to build the research evidence needed to develop appropriate and acceptable interventions, and to inform effective treatment strategies.

Effectiveness of IADL interventions to improve functioning in persons with Schizophrenia: A systematic review

BACKGROUND OF THE STUDY

Instrumental activities of daily living (IADL) are activities that are needed to live an independent life. Psychotic disorders are associated with deficits in everyday functioning, causing impairment/disability in activities of daily living. Activities play a crucial role to measure functional health or disability. People with Schizophrenia often present difficulties in social and occupational reintegration that may be associated with problems in performing daily activities, including independent living, education, working, and socializing. Activities of daily living and instrumental activities of daily living (life skills training) including leisure and social skills training intended to reintegrate the patient into the community to lead an everyday life.

AIM

The aim of this review was to identify the effect of skill-based interventions on independent functioning in persons with Schizophrenia.

METHODS

The authors conducted database searches of Google Scholar, PubMed, Science Direct, ProQuest, EBSCO from 1st January 1992 to 31st December 2020. The researcher extracted data, and the quality of included studies was rated by two authors independently. We used the Cochrane Risk of Bias (ROB) tool for assessing the quality of selected studies. The search identified nine studies that met the inclusion criteria with 655 participants. The outcome measure was independent functioning skills.

RESULTS

The interventions in the review were multifaceted with different combinations of psychoeducation, cognitive-behavioral methods, training in social skills, and IADL. The interventions resulted in significant improvement in functioning skills and reduction in relapse rates.

CONCLUSION

Results of this review have revealed moderate to strong evidence for skills training, either behavioral or social skills to improve social and independent functioning, reduce caregiver burden, and improve negative symptoms. The review also supported that interventions could be generalized across settings.

Effects of occupational balance and client-centered occupational management in a patient with schizophrenia

BACKGROUND

Occupational balance is an essential element for social participation and quality of life. However, it is difficult for patients with schizophrenia to participate in occupation and achieve occupational balance in daily life due to physical and mental symptoms.

OBJECTIVE

This study investigated the form of time use and occupational balance in a schizophrenic patient, and examined the effect of client-centered occupation-based case management.

METHODS

The research was conducted at a private center visited using one-on-one weekly client interactions for 10 weeks from September 1, 2020, and time use was analyzed using the Occupational Questionnaire (OQ) and the 2019 Life Time Survey Table of the National Statistical Office. In addition, data on work performance and satisfaction were collected using Canadian Occupational Performance Measure (COPM), and client-centered occupation-based interventions were conducted.

RESULTS

As a result of identifying the balance of work of clients, 38.46% of rest and sleep during the day, 30.77% of IADL, 17.94% of Work, 10.26% of BADL, and 2.57% of leisure. Through occupation-based case management for child care and work, which are the main goals of the client, the COPM score increased on average by 2 or more points per item, showing a positive effect.

CONCLUSION

In order to resolve the occupation imbalance of schizophrenic patients, it is necessary to closely understand the type of time use and actively intervene in client-centered occupation-based interventions.

DATA AVAILABILITY STATEMENT

Data pertinent to this report will be made available upon reasonable request to the author.

Psychometric properties of the Community Integration Questionnaire - Revised (CIQ-R) in an Italian population with spinal cord injury

STUDY DESIGN

Psychometric study.

OBJECTIVES

The aim of this study was to evaluate the internal consistency and validity of the Community Integration Questionnaire - Revised (CIQ-R) in Italian individuals with spinal cord injury (SCI).

SETTING

Patients' associations, foundations, sport clubs, and federations in Italy.

METHODS

The psychometric properties were evaluated following international guidelines. Internal consistency was assessed using Cronbach's alpha (α) coefficient, and test-retest reliability was assessed using intraclass correlation coefficient (ICC); concurrent validity was assessed through Pearson's Correlation Coefficient with the Short Form-12 health survey (SF-12).

RESULTS

The test was administered to 80 people with SCI. Cronbach's α showed a value of 0.825 for the Home Integration subscale, while the other subscales and the total showed values <0.70. 30 of the 80 recruited individuals were submitted to test-retest, which showed ICC values ranging from 0.94 to 1. CIQ-R also showed a correlation between Physical Component Summary (PCS12) of the SF-12, and between Social Integration subscale's score and PCS12 and Mental Component Summary (MCS12). Correlations are also shown between Productivity subscale and PCS12 and MCS12, as well as between the total score and PCS12 and MCS12.

CONCLUSION

This study provided Italian clinicians and researchers with the first international outcome measure for measuring community integration. The validation of this measurement tool for people with SCI allows to compare outcomes of various studies. It is useful for testing the effectiveness of a treatment in various diseases and define which treatment is more effective than others.

Perceptions of Occupational Therapy Educators about the Educational Preparation of Occupational Therapists for Designation as Qualified Mental Health Professionals

This study investigated educators' perspectives on whether occupational therapists were educationally prepared for designation as Qualified Mental Health Professionals (QMHPs) using a cross-sectional survey design followed by interviews to gather qualitative data. Fifty-two educators responded to an electronic survey questionnaire. Six of the 52 participants volunteered for follow-up interviews. Most educators (64.58%) thought that occupational therapists were prepared for designation as QMHPs (p=.04). Interview data indicated that educational programs prepared students for psychosocial practice using various content delivery methods. Occupational therapists need to advocate for recognition as significant contributors to the treatment of people with mental health challenges.

Establishment of Reliability of the Occupation-Based Practice Assessment

The profession's foundational construct; occupation, is therapeutically effective, but there remains inconsistent use as a therapeutic medium. A psychometrically strong tool can measure and maximize the use of occupation. This study establishes preliminary psychometric properties of the Occupation-Based Practice Assessment (OBPA). This methodological study tested inter-rater reliability using simulated video cases to examine the OBPA. Overall reliability was acceptable with at .868. All subsections were acceptable including Meaning and Purposeful Occupation (.871), Therapeutic Intent (.819), and Engaged Participation (.807). Two items, Context (.946) and Actual Doing (.981), demonstrated excellent reliability; while three items, Meaning (.747), Adaptation (.799), and Participation (.735), fell slightly below the acceptable level. Preliminary investigation of the OBPA reveals acceptable inter-rater reliability and suggests potential for use following additional in-vivo testing to measure therapeutic interactions to enhance student learning, optimize clinical practice, facilitate professional development, evaluate programs, and quantify occupation-based practice in research.

The effectiveness of a combination of Occupational Therapy and Social Skills Training in people with schizophrenia: A rater-blinded randomized controlled trial

Introduction

This study aimed to assess the impact of a holistic combination of Occupational Therapy and Social Skills Training on occupational performance, social participation, and clinical symptoms in people with schizophrenia.

Method

60 people with schizophrenia were randomly assigned to two groups. One group received standardized Social Skills Training once a week for a total of 10 sessions, while the other group received a combination of Occupational Therapy and Social Skills Training once a week for a total of 16 sessions.

Results

A greater increase was determined in the scores of COPM total performance/satisfaction and the Community Integration Questionnaire in the Occupational Therapy and Social Skills Training group. Furthermore, these achievements were sustained in the Occupational Therapy and Social Skills Training group compared to the Social Skills Training group at the 6-month follow-up.

Conclusion

The clients received the combination of Occupational Therapy and Social Skills Training showed a better improvement compared to the Social Skills Training group in terms of occupational performance, social participation, and severity of clinical symptoms. The use of Occupational Therapy in a holistic approach in psychosocial rehabilitation of people with schizophrenia can increase their functionality and social participation. Further studies are needed to assess long-term effects of Occupational Therapy in schizophrenia.

Role of Occupational Therapy in Primary Care

The American Occupational Therapy Association (AOTA) affirms that occupational therapy practitioners1 are well prepared to contribute to interprofessional collaborative care teams addressing the primary care needs of individuals across the life course. Because of an increased focus on preventive population health and social determinants of health by health care organizations, synergy between primary care and occupational therapy is growing, with support for client-centered,2 comprehensive whole-person care, health promotion and prevention, disease self-management, and quality of life (Halle et al., 2018). Occupational therapy practitioners’ distinct knowledge of the significant impact that roles, habits, and routines have on health and wellness makes their contribution to primary care valuable (AOTA, 2020b). Occupational therapy’s focus on meaningful engagement in occupations is relevant and vital to participation in individual, family, and community life (AOTA, 2020c). In addition, occupational therapy practitioners’ holistic and population perspectives allow them to be effective both as interprofessional health care team members and as direct care providers to support client, family, and community needs in primary care delivery models (Leland et al., 2017). The purposes of this position paper are to define primary care and to describe occupational therapy’s evolving and advancing role in primary care, including expansion of services into specialty primary care areas such as pediatric primary care and obstetrics and gynecology (AOTA, 2018).

Mental health consumers’ perspectives on using an occupation-focused assessment to initiate change in everyday activities

Introduction

Engagement in meaningful activities is central to recovery for people with mental health conditions. The aim of this study was to examine the utility of an occupation-focused assessment, the Daily Experiences of Pleasure, Productivity, and Restoration Profile, as a means to guide engagement in meaningful activity.

Methods

Eight consumers who were receiving services from a community-based behavioural health centre utilized the Profile to set and work towards self-identified goals. Data derived from audiotaped sessions, notes, and a focus group were analysed using an iterative content analysis process.

Results

Three themes emerged: completion of the Profile was ‘burdensome, but right on’, moving from insights gained to choosing and working towards a goal required guidance from the therapist, and insights gained from the Profile supported some changes in actions and perspectives.

Conclusion

The findings support preliminary utility of the Daily Experiences of Pleasure, Productivity, and Restoration Profile to guide engagement in meaningful activity among people living with mental health conditions. Moreover, the support and guidance of the occupational therapist is critical. Continued examination of the use of the Profile is warranted to help support occupational therapy’s role in promoting recovery for people with mental health conditions through meaningful activities.

Occupational Therapy's Value in Provision of Quality Care to Prevent Readmissions

Health care systems are prioritizing the quality of outcomes over the quantity of services provided, and health care payers and other stakeholders are focusing on preventing hospital readmissions. This priority supports the effort to reduce the cost of health care by avoiding the most expensive care type and improving the quality of health care by promoting sustained return to the community and remaining in the community. Occupational therapy practitioners have expertise that is critically important in this effort. Occupational therapy places a unique and immediate focus on patients' functional and social needs, which can be important drivers of readmissions if they are not addressed. By addressing activities of daily living, instrumental activities of daily living, functional cognition, psychosocial needs, vision, fear of falling, and safety, occupational therapy practitioners can be a valuable addition to the effort to keep people out of the hospital and participating in their lives. This article reviews the literature supporting the role of occupational therapy in each of these key areas.

Cognition, Cognitive Rehabilitation, and Occupational Performance

The American Occupational Therapy Association (AOTA) asserts that occupational therapists and occupational therapy assistants, through the use of occupations and activities, facilitate clients’ cognitive functioning to enhance occupational performance, self-efficacy, participation, and perceived quality of life. Cognitive processes are integral to effective performance across the broad range of daily occupations such as work, educational pursuits, home management, and play and leisure. Cognition plays an integral role in human development and in the ability to learn, retain, and use new information to enable occupational performance across the lifespan.

This statement defines the role of occupational therapy in evaluating and addressing cognitive functioning to help clients maintain and improve occupational performance. The intended primary audience is practitioners1 within the profession of occupational therapy. The statement also may be used to inform recipients of occupational therapy services, practitioners in other disciplines, and the wider community regarding occupational therapy theory and methods and to articulate the expertise of occupational therapy practitioners in addressing cognition and challenges in adapting to cognitive dysfunction.

Occupational Therapy Interventions for Adults Living With Serious Mental Illness

Occupational therapy practitioners have education, skills, and knowledge to provide occupational therapy interventions for adults living with serious mental illness. Evidence-based interventions demonstrate that occupational therapy practitioners can enable this population to engage in meaningful occupations, participate in community living, and contribute to society. Systematic review findings for occupational therapy interventions for adults living with serious mental illness were published in the September/October 2018 issue of the American Journal of Occupational Therapy and in the Occupational Therapy Practice Guidelines for Adults Living With Serious Mental Illness. Each article in the Evidence Connection series summarizes evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. These articles illustrate how research evidence from the reviews can be used to inform and guide clinical decision making. Through a case story, this article illustrates how current evidence is applied for effective occupational therapy intervention with an adult living with serious mental illness.

Effectiveness of Occupational Therapy Services in Mental Health Practice

National behavioral health care efforts have opened opportunities to reignite occupational therapy mental health practice and research. The profession's person-centered and occupation-based practice fits well with the growing needs of people with serious mental illness (SMI) served in community-based settings. The nine articles in this special issue provide a growing body of evidence to support the effectiveness of occupational therapy interventions for adults with SMI to enhance health management skills and promote independence in living a balanced and satisfying life. However, much more high-level research is required to explicitly investigate the contributions of occupational therapy in all areas of occupation for adults with SMI and to broaden the available evidence base to inform occupational therapy practice.