How do occupational therapy curricula align with priorities identified by occupational therapists to prepare graduates for working in mental health?

All professional preparation programs need to ensure that university curricula remain reflective of current practice, and also prepare graduates for practice in the future. Upon formation, the Australia and New Zealand Occupational Therapy Mental Health Academics (ANZOTMHA) network identified that there was insufficient or poorly organised information available about how well current occupational therapy curricula prepared students for practice in the field of mental health. One of the first priorities established by ANZOTMHA was to undertake a program of research to examine this issue. The aim of this report is to summarise and integrate the outcomes of two inter-related studies to explore the extent to which current occupational therapy university curricula in Australia and New Zealand match educational priorities identified by practising occupational therapists in mental health

Dealing with the ‘double-whammy’: women’s experiences of schizophrenia and weight gain

Research Doctorate - Doctor of Philosophy (PhD)In this study I explored the experience of women diagnosed with schizophrenia spectrum disorders (SSDs) of managing their weight and what they thought had, or would support them to do this more effectively. I carried out the study according to the principles of constructivist grounded theory. Participants in the study were women, who had been diagnosed with SSDs, were not acutely unwell, and were able to give informed consent. I recruited the participants through community mental health rehabilitation services in the Hunter Region of New South Wales. Data was generated through in-depth, semi-structured interviews. Each of the 11 women who participated in my study engaged in between one and three interviews over a two-year period. I carried out data analysis alongside the data generation, with each process informing the other. Data analysis involved a two-stage coding process characteristic of grounded theory. I also employed other analytical tools including writing analytical memos, constant comparison, theoretical sorting and storyline. The findings of the study comprise a theoretical framework that has four components. The first component is the basic social problem that was shared by all of the participants in the study. Labelled using the words of one of the participants, <i>the double-whammy</i> describes the women’s experience of weight gain, often resulting in obesity, as a second whammy that came along with the diagnosis and treatment of their SSD and brought with it additional challenges. The remaining three components comprise the basic social process, which was the women’s response to <i>the double-whammy</i>. This response centres on the core category of <i>doing as much as I can</i>. This category includes the women’s engagement in what they saw as <i>doing the right things</i>, in a somewhat cyclical process of <i>starting to do it</i> on more than one occasion due to the challenges of <i>sticking with it</i>. They also described an ongoing process of <i>adjusting expectations</i>, both in terms of their engagement in <i>doing the right things</i>, and the outcomes they expected to achieve. The women’s ability to do what they saw as necessary to manage their weight fluctuated in response to a range of <i>mediating factors</i>, which formed the second category in the basic social process. These <i>mediating factors</i> included, <i>knowing</i> about the potential for weight gain and how to address it, <i>mental health and wellbeing</i>, and <i>practical issues</i> such as living on a limited income and prioritising managing their weight among competing demands. The final component of the findings was the <i>facilitating factors</i> that the women thought had helped, or would help them to manage their weight. These included, <i>talking about it</i>, <i>having a plan</i>, and having <i>someone to do it with</i>. This study is significant in that it provides insight into the experience of women, who are generally underrepresented in research about SSDs. The study also provides a longitudinal and holistic perspective that has not been present in existing research. Based on the findings above I suggest that interventions to address weight gain and obesity for women with SSDs should: be integrated with interventions for mental health, commence concurrently with treatment for their SSD, be long term, be flexible and individualised, support development of competence in associated activities, address environmental and contextual factors, and happen in the context of supportive relationships. These suggestions have implications for mental health service providers including addressing culture and attitudes and developing knowledge and skills among staff and allocating sufficient resources to enable obesity to be effectively addressed in mental health services. Implications for occupational therapy include validation of occupation centred practice in this field given the identification of developing competence in associated activities as one of the core elements of interventions to address weight gain and obesity in women with SSDs

Simulated patients in a mental health occupational therapy course: a pilot study

Introduction: The use of simulated patients is well established in medicine and nursing. There is little research evaluating the use of simulated patients in occupational therapy education and none which focuses on mental health. This study sought to determine the acceptability and effectiveness of using simulated patients in a mental health occupational therapy course. The pilot also sought to address the challenge of providing simulation experience to a large number of students in a cost and time effective manner. Method: Occupational therapy students participated in a simulation which involved an initial interview assessment with an actor portraying a person with a mental health diagnosis. The students worked in small groups for the simulation, rotating into the therapist role using a carousel model. Students completed a survey about their experience of the simulation. Results: The students rated the simulation experience highly in terms of authenticity and learning outcomes. Qualitative analysis of open-ended responses produced five themes: authentic experience, developing skills, feedback and reflection, we should do more of this, and developing the experience further. Conclusion: The pilot was effective in allowing a large number of students to engage directly with the simulated patient without negatively impacting on the experience

How mental health occupational therapists address issues of diet with their clients: A qualitative study

Background: Poor diet is a contributing factor to the high rates of obesity and related comorbidities in people with severe mental illness, and dietary change is a key treatment strategy. Providing healthy lifestyle interventions is a recognised role for occupational therapists. However, the existing literature fails to elucidate boundaries of this role. To begin to address this gap in the literature, this study explored the attitudes, actions and beliefs of mental health occupational therapists about providing diet-related interventions. Methods: Semi-structured interviews were conducted with mental health occupational therapists working in one Area Health Service in New South Wales. Purposive sampling was used. Data were analysed using Constructivist Grounded Theory methods, where meaning is co-constructed by, and the theory ultimately grounded in the experiences of, the participant and researcher. Results: The participants felt confident providing clients with interventions to promote diet-related skill development and providing general healthy eating education to support this development. However, they were not comfortable providing clients with specific dietary advice. Participants identified a need for further training and support to enhance their effectiveness in providing healthy eating education and highlighted the need for more dietitians in mental health services. Conclusions: The occupational therapists in this study identified clear boundaries of their role in providing diet-related interventions for people with severe mental illness. Suggestions for improvement in this area included further training for occupational therapists as well as increased access to dietitians for those services that lie outside the occupational therapy role

Occupational therapy and obesity: an integrative literature review

Background/aim: Obesity is a significant public health concern globally. It is associated with poor physical health, mental health and subjective well-being and limitations on occupational participation. With its focus on the relationship between occupation, health and well-being, occupational therapy would appear to be well placed to address both the causes and consequences of obesity. The aim of this review was to explore the scope of the role of occupational therapy practice in this field and the supporting evidence base. Methods: Searches were conducted in four online databases and nine occupational therapy journals. Articles were included if they were theoretical, quantitative or qualitative research, explicitly related to occupational therapy and obesity, published in peer-reviewed journals, in English between 2002 and 2012. All research articles were critically reviewed and thematic analysis was conducted across all of the articles in the review. Results: Eight theoretical articles, 12 quantitative and two qualitative research studies were included. Only three were outcome studies. Thematic analysis identified four categories of focus of occupational therapy intervention: health promotion and prevention, increasing physical activity participation, modifying dietary intake and reducing the impact of obesity. Four categories of intervention strategies were also identified; assessment, modifying the environment, education and introducing and adapting occupations. Conclusion and significance: The findings of this review suggest a comprehensive role for occupational therapy in addressing obesity. However, the paucity of outcome studies mean that significantly more research is required to further define and provide a strong evidence base for occupational therapy practice in this emerging field

Identifying educational priorities for occupational therapy students to prepare for mental health practice in Australia and New Zealand: opinions of practising occupational therapists

BACKGROUND: The effective preparation of occupational therapy students for mental health practice is critical to facilitate positive consumer outcomes, underpin optimal practice and support new graduates\u27 professional identity. This project was established to determine a set of \u27educational priorities\u27 for occupational therapy students to prepare them for current (and future) entry-level practice in mental health, from the perspective of mental health occupational therapists in Australia and New Zealand. METHODS: The study included two phases. In Phase One, participants identified what they considered to be important educational priorities for occupational therapy students to prepare them for practice in mental health. For Phase Two, an \u27expert panel\u27 was assembled to review and rank these using a Policy Delphi approach. RESULTS: Eighty-five participants provided educational priorities in Phase One. These were grouped into a total of 149 educational themes. In Phase Two, the expert panel (consisting of 37 occupational therapists from diverse locations and practice settings) prioritised these themes across three Delphi rounds. A final priority list was generated dividing educational themes into three prioritised categories: 29 \u27Essential\u27, 25 \u27Important\u27 and 44 \u27Optional\u27 priorities. Highest-ranked priorities were: clinical reasoning, client-centred practice, therapeutic use of self, functional implications of mental illness, therapeutic use of occupation and mental health fieldwork experience. CONCLUSION: The priority list developed as part of this project provides additional information to support the review of occupational therapy curricula across Australia and New Zealand to ensure that new graduates are optimally prepared for mental health practice

Mental health consumer involvement in occupational therapy education in Australia and Aotearoa New Zealand

Introduction: Recovery-oriented practice policies and occupational therapy education accreditation standards require that consumers are engaged in the design, delivery and evaluation of curricula. This consumer involvement (sometimes referred to as service-user involvement or patient involvement in other contexts) should go beyond consumers simply ‘telling their stories’ to more meaningful collaboration in curricula. This study was designed to map the current patterns of consumer involvement in occupational therapy programs across Australia and Aotearoa New Zealand. Method: A survey was distributed to all occupational therapy programs across Australia and Aotearoa New Zealand. The survey included questions related to: (a) perceived enablers and barriers to consumer involvement in education; (b) organisational structures and support; (c) ways in which consumer are involved in the design, delivery and evaluation of curricula; (d) access to remuneration for consumers; (e) overall ratings of the level of consumer involvement in curricula; and (f) academic confidence in working with consumers. Results: Usable responses were received for 23 programs from 19 universities (83% response rate). Every program reported some consumer involvement in the curriculum. Consumer participation tended to be mainly focussed on curriculum delivery with less frequent involvement in curriculum design or evaluation. The most common barrier to consumer involvement in curricula was ‘funding/remuneration for consumers’ and the most common enabler of consumer involvement was ‘positive attitudes of teaching staff’. Conclusion: In comparison to previous reports, consumer involvement in occupational therapy curricula has increased over the past decade. However, ongoing effort is required to support true collaboration in all aspects of curriculum design, delivery and evaluation. While this will require attention and effort from academic teams, changes at a university level to establish systems to engage and effectively remunerate consumers for their involvement (especially in design and evaluation elements) are also required