TRANSFORMING LIVES TO BUILD INDEPENDENCE Ashok Bhagat Occupational - - PowerPoint PPT Presentation

TRANSFORMING LIVES TO BUILD INDEPENDENCE

Ashok Bhagat

Occupational Therapy Supervisor Mental Health Service

CONFLICT OF INTEREST As speaker in this session I have no conflict of interest or disclosure in relation to this presentation.

LEARNING OBJECTIVES

At the end of this session, participants will be able to: q Identify the Occupational therapy program available in the community focusing on return to work q The effectiveness of occupational therapy community-based interventions in helping clients with mental illness to return to work or previous occupational roles, irrespective

• f their diagnosis

q The quantitative analysis of the clients with mental illness in terms of return to work q How stigma affects the return to work or role of our clients in community

INTRODUCTION

Services for individuals with mental illness have shifted from the hospital to the community , there has also been a shift in the philosophy of service delivery. In the past, there was an adherence to the medical model; now the focus is on incorporating the recovery model q RECOVERY MODEL: qAcknowledge that recovery is a long-term process, with the ultimate goal being full participation in community activities q Activities may include obtaining and maintaining employment, going to school, and living independently qThis model is a good fit with Occupational Therapy in community mental health because it increases an individual’s ability to live independently as possible, while engaging in meaningful and productive life roles Occupational therapy facilitates participation and is client-centered, it plays an important role in the success of those recovering in the community (American Occupational Therapy Association (AOTA)

REVIEW OF LITERATURE

q Helping patients with common mental health problems return to work, by Paul Nicholson, John CD Gration, British Journal of General Practice, 2018.The two largest causes of sickness absence are, unsurprisingly, musculoskeletal disorders and common mental health problems (CMHP), that is, anxiety, depression, and stress. Much research has postulated how work and CMHP may be related q RETURN TO WORK INTERVENTIONS In this study, GPs saw their responsibilities to include early diagnosis; identifying the cause; empowering patients to find their own solutions; psycho-education; regular review; advising regular contact with work; and collaborating with an occupational depression

REVIEW OF LITERATURE

q Occupational rehabilitation programs for musculoskeletal pain and common mental health disorders: study protocol of a randomized controlled trial, Marius S Fimland1,2, Ottar Vasseljen1, Sigmund Gismervik1,3, Marit By Rise1, Vidar Halsteinli1, Henrik B Jacobsen4,Petter C Borchgrevink2,4, Hanne Tenggren2 and Roar Johnsen1, BMC Public Health q Sick leave is a major problem in the western world. Norway is considered to have a high level of sick leave and approximately 10% of the workforce is on disability

• pension. Hence, it is necessary to develop services that help people to stay at work,

including effective rehabilitation models

AIM

q The goal of this project was to reintegrate mentally ill clients back into their community to perform their roles and work.

q The primary goal of occupational therapy (OT), as part of the rehabilitation program, is to enable people to participate in the activities of everyday life including the ability to work q Restoring the ability to work is a key element in the rehabilitation of adult patients (aged 20-55 years) q Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the “occupations’ (used in terms of activities, and not only referring to employment) they want to, need to,

• r are expected to do

q OT can involve, in order reaching the therapeutic goals, modifying the occupation itself or the environment

METHODOLOGY

q The project is based mainly on quantitative measures a using standardized outcome measure q Initial OT evaluation was completed and all the clients underwent various prescribed evidence based intervention according to their respective diagnosis q The total of 46 female day care patients attended OT services for the period of 4 years and 6 months from January 2013 to august 2017

CONTINUED….

q Out of 46 female clients, 19 were Qataris and 27 non-Qataris age ranging from average of 20 to 55 years q Inclusion criteria for the project are both psychotic and neurotic disorders including intellectual disorders. Others problems were excluded q Among 46 patients 29 were diagnosed with psychosis and 17 were of neurosis origin including intellectual disorder

OUTCOME MEASURES

COPM (Canadian occupational performance measure) q The Canadian Occupational Performance Measure (COPM) is an important tool designed for use by Occupational Therapists, the measure serves to identify issues of personal importance to the client and to detect changes in a client’s self-perception of occupational performance over time q The COPM, which initiates the conversation with clients about performance issues in everyday living, provides the basis for setting intervention goals Recovery assessment scale (RAS) q A reliable test with high internal consistency developed for individuals with serious mental illness Engagement in meaningful activities survey (EMAS) q A self-rating scale that measures the extent of engagement in meaningful activities and captures description of the participants’ activity involvement

Oc Occupatio ional al therap apy Interventio ion in in Co Community y mental health

q Evaluating and assessing the environment at home, work, school, and other environments to promote an individual’s optimal functioning

.

.

CONTI TINUED…. ….

q Facilitating the development

• f skills needed for

independent living such as using community resources, managing one’s home, time, medication, and being safe at home and in the community

CONTINUED….

q Facilitating and Providing activities of daily living (e.g. hygiene and grooming) to improve self maintenance and promote self-reliance

DA DATA ANALYSIS

qStatistically significant improvement is seen compared to values of initial assessment and pre discharge assessment using COPM scale, also the patient satisfaction questionnaire was used to get feedback of clients on OT intervention qThe feedback of most the clients who were sent back to community were very satisfied with the OT intervention which in turn credits the OT role in the Mental health qThe RAS-DS is a Likert scale has 38 items with 4 rating categories for consumers to select from : untrue, a bit true, mostly true and completely true qEMAS was developed to measure the extent of engagement in meaningful activities. It uses a self- rating Likert scale qOut of 14 participants 8 reported highly satisfied in engaging in meaningful activities. 5 reported moderate satisfaction and 2 reported low satisfaction qCorrelation between the RAS & EMAS SCALE reveals that as a client recovery their satisfaction in engagement in meaningful activities have increased

Th The Comparison of Pr Pre and Post Mean sc scor

• res

s on

• n

pe performanc nce and nd sa satisfaction

• n in

Ca Canadian

• c
• ccupation
• nal

th therapy pe performanc nce me measure

Th The combined results of Patient – Fa Family Sa Satisfaction

• n Question
• nnaire

2 4 6 8 10 12 14 16 18 20 1 2 3 4 5 6 7 8 9 10 11 12

Patient Satisfaction Questionnaire scores

Very Satisfied Satisfied Neither satisfied nor dissatisfied Some what dissatisfied very dissatisfied

X axis = No. of Questions Y axis = Scores

This graph reveals the client’s level of satisfaction with regards to the quality of services in the areas of therapeutic environment, Therapist attitude, duration of sessions , goal settings and overall expectation was very satisfactory

The Comparison Of Pre And Post Scores On Performance ce And Satisfact ction In Canadian Occu ccupational Therapy Performance ce Measure

COPM COMPONENTS PRE POST 95% confidence interval of difference ‘P’ VALUE Performance 4.38 4.98 0.6 (0.46, 0.72) <0.0001 Satisfaction 2.97 4.62 1.65(1.44,1.85) <0.0001

EM EMAS SCALE

8, 57% 4, 29% 2, 14%

Engagement in Meaningful Activies Survey

High Moderate Low

CO CORRELATION BETWEEN THE RAS & EMAS SCALE

34 35 44 44 47 50 56 39 41 44 60 21 55 34

10 20 30 40 50 60 70 20 40 60 80 100 120 140 160

𝑆" Linear = 0.273 RAS SCORE EM EMAS SCORE Graph shows positive correlation between the RAS & EMAS Scale. This finding reveals that as a client recovers their satisfaction in engagement in meaningful activities have increased

RESULTS

q The total of 32 clients out of 46 who were integrated back to work or their previous role gives us a significant result q The final scores of COPM were helpful to statically prove the clients who scored high values are being successfully sent back to meaningful work in community q Out of 19 Qatari clients, 12 were successfully rehabilitated back to their role and 7 clients are still undergoing OT intervention due to relapse q Out of 27 non Qatari clients 20 were successfully rehabilitated back to work and their role, 7 Clients still undergoing OT intervention q 14 clients who are receiving OT intervention have shown significant improvement towards recovery and satisfaction in engaging in meaningful activities

CHALLENGES

q Interest among client’s to work is limited q Lack of awareness among employer q Information and education about effectiveness of work is inadequate q Lack of training for Intervention strategies q Laws to support rights of mentally ill clients q Workplace stressors q Deficient in provision of support to the employee recovered from illness q Residual symptoms or remission of illness can affect productivity q Stigma related to mental health

q Ignorance of mental illness q Limited opportunities for clients to work or approach for work q Clients are considered as incapable of work q Believed to be dependent or burden on society q No confidence on clients abilities q Poor Acceptance among family and community q Fear of People judgmental attitude q Considering all the clients are aggressive and homicidal

STIGMA

OUTCOME & FOLLOW-UP

q The major impact of clients in returning to their role immediately after the hospitalization provided a tremendous self-motivation q They also gained self-confidence to step back into the previous responsibilities like professional jobs, skilled work, household work, school or college etc., q In some situations the clients may not fit into their exact previous occupational roles and responsibilities, but still they were ready to take over the jobs with newly learned skills in a different prospective of the same career q Furthermore, establishing supported employment or occupational rehabilitation within community mental health service q 14 clients are receiving OT interventions and under regular follow up

CONCLUSION

q This project reflects the outcome of Occupational Therapist efforts rehabilitating mentally ill back to their job or placing them job related work, self-employment, working in sheltered workshop and managing household activities effectively, developed self-respect and adaptation in community q The project is designed to continue to help persons with serious psychiatric disabilities function with success and satisfaction in their environments and to provide a continuum of services that allows patient and their families, the right to make choices regarding services q The aim of the intervention is to highlight the importance of focusing on the whole person rather than the illness or the disability

FUTURE PLAN

qImprove Community return to work program and develop supported employment within community mental health service qImprove current pre-vocational and vocational training to develop, improve and maintain work skills

RE REFERE RENCE CE S

q American Occupational therapy Association (AOTA), 2010, Scheinholtz, 2010 q Brown C,& Stoffel (2011). Occupational therapy in mental health: A vision for participation. Philadelphia: F.A.Davis q Scheinholtz.M, (2010) Occupational therapy in mental health: Considerations for advanced

• practice. Bethesda, MD, AOTA Press

q Andrew McCulloch, Returning to work, the role of depression q Mary Law, Sue Baptiste, Anne Carswell, Mary Ann McColl, Helenne Polatajko, Nancy Pollock, Canadian Occupational performance measure

THANK YOU