Psychosocial Practice

OT Role

• The OT scope addresses the client and contextual factors that support the successful transition from institution to community living.¹ 
• Occupational therapy practitioners provide a distinct value and role for promoting clients’ medication management and treatment.^2 3 

Overview of Theories

• Recovery Perspective: multidisciplinary approach that can increase the likelihood that transition to the community will be successful and sustained long-term.⁴ 
• Allen Cognitive Disabilities Model: see lesson
• Cognitive Disabilities Model: biopsychosocial perspective on function and “can do, will do, may do”.⁵ 
• Intentional Relationship Model: views the therapeutic use of self as fundamental to the understanding, approach, and interactions for practice for improving function with clients.⁶ 
• Behavior Modification: operant conditioning, reinforcement, rewards.
• Cognitive-Behavioral Therapy (CBT): see blog post
• Kawa Model: uses the metaphor of a river to create a picture of the client’s life and its circumstances from an East Asian perceptive.
  • The client is integral to the environment and its social context.
  • Life, life energy, well-being, flow
  • Water, rocks, driftwood, river side-walls, bottom floor, space.⁷ 
• Model of Human Occupation: considers the impact of volition, performance, and habituation on the engagement of occupations.⁸ 
• Person-Environment-Occupation-Performance Model: considers the client, their environment, occupation, and performance as key components on health, wellness, and the quality of life.⁹ 
• Psychoanalytic/psychodynamic: useful for exploring underlying client motivations.

OT Recommendations

• Evaluate and provide interventions to improve the performance of ADLs, IADLs, health, sleep, and safety in community living.¹⁰ 
• Address affective, cognitive, perceptual, sensory, and motor functions.
• Address performance skills (motor, process, communication, social)
• Address performance patterns (habits, roles, routines, rituals)
• Analyze the interaction between the person, task, and environment.
• Work with clients to identify strategies and strengths to improve occupational performance in their daily habits and routines.
• Educate and provide effective strategies for team members to assist in the goals.
• Incorporate the use of natural supports into the intervention plan.¹¹ 

Treatment Settings

Most severe to least severe

• Inpatient Residential: is considered when outpatient approaches are not successful. Intended to be short-term length of stay to stabilize the client and for them to return to the community. Clients do not need medical attention. Treatment may be group, individual, or family.
• Inpatient Acute: clients need 24-hour care and often are not able to care for self. Length of stay often lasts a few days until the crisis is stabilized. Intervention includes group therapy and meeting with other professionals. Family sessions may be provided as part of discharge planning.
• Partial Hospitalization: is an intense structured programs that lasts 5-7 days per week. Includes group, individual, and family therapy. Often includes psychiatrist management and medications. Recommended for those who are at risk for hospitalization and continue to experience emotional/behavioral problems.
• Intensive Outpatient Program: is a structured treatment program to help cope with emotional and behavioral issues. Includes group, individual, and family therapy. Usually 3-5 days per week. Clients often work on normal daily routines.
• Routine Outpatient Care: may include (1) individual counseling, (2) medication management, and (3) group therapy.
• 12-Step Programs: are often free community-based programs such as Depressed Anonymous, Emotions Anonymous and the National Alliance on Mental Illness (NAMI). Helps clients to achieve optimal mental health by offering support and strategies for recovery.¹² 

Other Settings

• Community Mental Health Clinics/Centers¹³ 
• Assertiveness community treatment (ACT): provides comprehensive local-based treatment for persistent mental illnesses. A highly-individualized services direct to consumers in their home and community. Goal is to lesson the burden of symptoms on the client and to minimize recurrent episodes. ACT helps to meet the basic needs for a quality of life and to improve social and employment roles in the community. ACT includes treatment, rehabilitation, and other supportive services.¹⁴ 
• Homeless and women’s shelters
• Correctional facilities
• Senior centers¹⁵ 
• Consumer-operated service programs (COSPs): hierarchically organized consumer-operated programs that are viewed as organizations that promote recovery while working with community mental health agencies. Services include drop-in centers, clubhouses, independent living centers, case management services, employment agencies, and supported housing.¹⁶ 
• After-school programs
• Homes
• Worksites¹⁵ 
• Day Treatment Programs¹⁷ 
• Skilled Nursing and Board and Care¹⁸ 
• Home Health¹⁹ 
• Halfway Houses and Supported Housing: facilitate the transition from institution to community.^20 11 
• Employment (Supported, Transitional, Prevocational, Vocational) ²¹ 
  • Clubhouse Programs
• Telehealth or other Virtual^22 23 

1. American Occupational Therapy Association. (2010b). The Scope of Practice. The American Journal of Occupational Therapy, 64, S70–S77. doi: 10.5014/ajot.2010.64S70.[↩]
2. Schwartz, J. K., & Smith, R. O. (2017). Integration of medication management into occupational therapy practice. American Journal of Occupational Therapy, 71(4), 7104360010p1-7104360010p7.[↩]
3. Blum, J., Fogo, J., & Malek-Ismail, J. (2018). Medication Management in Home Health Care Occupational Therapy Practice. The Open Journal of Occupational Therapy, 6(4), 5.[↩]
4. Stoffel VC. (2008). Perception on the clubhouse experience and its impact on mental health recovery. Dissertation Abstracts International Section A: Humanities and Social Sciences, 68, 3300.[↩]
5. McCraith DB, Austin SL, & Earhart CE. (2011). The cognitive disabilities model in 2011. In N Katz (Ed). Cognition and Participation Across the Life Span. Thorofare, NJ: Slack Inc.[↩]
6. Taylor, R. R. (2020). The intentional relationship: Occupational therapy and use of self. FA Davis.[↩]
7. Wada, M. (2011). Strengthening the Kawa model: Japanese perspectives on person, occupation, and environment. Canadian Journal of Occupational Therapy, 78(4), 230-236.[↩]
8. Kielhofner, G. (2009). Conceptual foundations of occupational therapy practice (4th ed.). Philadelphia: F. A. Davis.[↩]
9. Baum, C. M., & Christiansen, C. H. (2005). Person–environment–occupation–performance: An occupation-based framework for practice. In C. H. Christiansen, C. M. Baum, & J. Bass-Hagen (Eds.), Occupational therapy: Performance, participation, and well being (3rd ed., pp. 242–267). Thorofare, NJ: Slack.[↩]
10. American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1). doi: 10.5014/ajot.2014.682006.[↩]
11. Mahaffey, L., Burson, K. A., Januszewski, C., Pitts, D. B., & Preissner, K. (2015). Role for occupational therapy in community mental health: using policy to advance scholarship of practice. Occupational therapy in health care, 29(4), 397-410.[↩][↩]
12. Cigna. (2011). Levels of Mental health Care Descriptions (Lowest to Highest). Retrieved from https://apps.cignabehavioral.com/cignabehavioral/media/consumer/educationAndResourceCenter/articles/levelsOfMentalHealth.pdf[↩]
13. Oruche, U. M., Downs, S., Holloway, E., Draucker, C., & Aalsma, M. (2014). Barriers and facilitators to treatment participation by adolescents in a community mental health clinic. Journal of Psychiatric and Mental Health Nursing, 21(3), 241-248.[↩]
14. NAMI Minnesota. 2017. Assertive Community Treatment (ACT) Retrieved from https://namimn.org/wp-content/uploads/sites/188/2018/05/Assertive-Community-Treatment_TreatmentOptions_2018.pdf[↩]
15. Brown, C., & Stoffel, V. (2011). Occupational therapy in mental health: A vision for participation. Philadelphia: F. A. Davis.[↩][↩]
16. Segal, S. P., Silverman, C. J., & Temkin, T. L. (2011). Outcomes from consumer-operated and community mental health services: a randomized controlled trial. Psychiatric services (Washington, D.C.), 62(8), 915–921. https://doi.org/10.1176/ps.62.8.pss6208_0915[↩]
17. Howes, J. L., Haworth, H., Reynolds, P., & Kavanaugh, M. (1997). Outcome evaluation of a short-term mental health day treatment program. The Canadian Journal of Psychiatry, 42(5), 502-508.[↩]
18. Pitman, T. (2010). Mini-Mental State Examination and Large Allen Cognitive Level Screen: Predictive validity for discharge disposition among patients of a skilled nursing facility.[↩]
19. Toto, P. E. (2006). Success through teamwork in the home health setting: The role of occupational therapy. Home Health Care Management & Practice, 19(1), 31-37.[↩]
20. Pitts, D. B. (2009). Introduction to special section on occupational therapy.[↩]
21. Bond, G. R. (2004). Supported employment: evidence for an evidence-based practice. Psychiatric rehabilitation journal, 27(4), 345.[↩]
22. Cason, J. (2012). Telehealth opportunities in occupational therapy through the Affordable Care Act. American Journal of Occupational Therapy, 66(2), 131-136.[↩]
23. Sánchez-Guarnido, A. J., Domínguez-Macías, E., Garrido-Cervera, J. A., González-Casares, R., Marí-Boned, S., Represa-Martínez, Á., & Herruzo, C. (2021). Occupational Therapy in Mental Health via Telehealth during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 18(13), 7138.[↩]