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Public stigma

negative stereotypes of individuals with the specific condition by others

Self-stigma

individuals agree with and internalize negative stereotypes

Labeling Theory

judgement from people with power and authority, deciding if behaviors deviate from the norm

• Overemphasizes the process of labeling

Normalization Theory

force individuals int a deviant role, their behavior and responses determined by the expectations surrounding that label

o Emphasize opportunities for social role development

o Emphasizes the need of a person with disability to change and “fit in” rather than for society adapting to accept the differences.

Structural stigma

restricts opportunities for people with mental illnesses or create unintended consequences that limit opportunities for participation

• OTs use skills to advocate and deconstruct stigma

Stigma in Mental Health Care

Negative attitudes and beliefs public stigma deterring help-seeking

Responses to Stigma in Mental Health Care

• Discrimination

• Social distance (excluding someone)

• Poor parenting

• Genetics

• Substance abuse

Affects of Stigma in Mental Health Care

• Negative impact on coping behaviors

  • Discrimination:

    • Housing

    • Education

    • Employment

What should OTs understand about stigma

• Client lived experiences of stigma

• Collaborate with client and family to address impact of stigma and cultural responses

Family Stigma

family, spouse, partner, and network of friends

Key attributes to family stigma

• Unusualness

• Member poses danger or threat

• Contamination

Measurements of stigma

• Self-Stigma of Mental Illness Scale

• Internalized Stigma of Mental Illness

• Both instruments can be used to understand the level to which a person self-stigmatizes.

• Practitioners should incorporate discussion of the results of these assessment tools.

Anti-Stigma Intervention

• Anti-stigma programs

• Education

• Social contact

• Advocacy

Public Stigma Intervention

contact based education

self-stigma intervention

narrative enhancement and cognitive therapy

reduction programs

Types of reduction programs

• Pyscho-education

• Cognitive-behavioral therapy

• Improves negative self-appraisal

• Motivational interviewing

• Social skills training

• Goal attainment

• Music therapy

Universalism

• marginality

• exclusion

• disaffiliation

Interventions for stigma and occupational justice

• Advocacy

• knowledge of civil rights

• Formation of strategic community alliances

• Working to remove attitudinal and other barriers in “regular” work environments

• Developing meaningful supported employment

• Exploring volunteerism and consumer-run businesses

Pryor & Reeder’s Model of Stigma

• System in place designed to be inequitable

• Stigma attached to you

• Stigma-bias

Evaluation Process Step 1

•Screen data to guide therapeutic reasoning

•Who is the person? What do I know? What are their concerns?

Evaluation Process Step 2

• Choose assessments

• Consider:

  • Utility (quality of life)

  • Validity (measure what intends to be measured)

  • Reliability (consistency of measure)

Evaluation Process Step 3

• Administer assessment

• Obtain consent

• Gather material

• Establish rapport

Evaluation Process Step 4

• Occupational profile

• AOTA template structure

• Identify occupational importance

Evaluation Process Step 5

Analyze occupational performance

Evaluation Process Step 6

• Synthesize data and set goals

  • Specific

  • Measurable

  • Attainable

  • Relevant

  • Time

Evaluation Process Step 7

•Reevaluate

• Ongoing process

• Measures outcomes

• Is intervention effective?

• Build body of evidence that supports occupational therapy

OT Process 1

Intervention

OT Process 2

Reevaluation

OT Process 3

Evidence-Based Practice in Mental Health

Examples of Health Disparities of Wellness

• High rates of smoking

• Sedentary lifestyle

• Symptom burden

• Poor self-care skills

• Higher disability status

• Lower (poorer) quality of life

• Social determinants of health

• Co-occurring medical and mental disorders

• Access to quality care

• Trauma

• Environmental contexts

• Economic factors

• Lifestyle factors

Roles of Occupational Therapy in Wellness (1)

balance of healthy lifestyle

Order doesn’t matter, disregard # (answer 1)

Roles of Occupational Therapy in Wellness (2)

• Collaboration between the provide and individual in recovery

• Holistic and client-centered approach

Order doesn’t matter, disregard # (answer is 2)

Roles of Occupational Therapy in Wellness (3)

• Health passport

  • Screening tool  mental illness & co-occurring illness

Order doesn’t matter, disregard # (answer 3)

Roles of Occupational Therapy in Wellness (4)

• Health promoting lifestyle profile 2

  • Questionnaire

Order doesn’t matter, disregard # (answer 4)

Roles of Occupational Therapy in Wellness (5)

• Wellness inventory

  • Likert scale —> mental illness & substance abuse

Order doesn’t matter, disregard # (answer 5)

Interventions for Wellness

• Spiritual dimension

• Social dimension

• Intellectual dimension

• Emotional dimension

• Occupational dimension

• Environmental dimension

• Financial dimension

Stubborn Shepherds Insist On Eating Food

Evidence-based practice

Conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients

Cycle 1 of EBP

Identify the problem & ask a question (Why)

Cycle 2 of EBP

Identify the relevant evidence (use key words to search)

Cycle 3 of EBP

Evaluate the evidence (critically appraise the quality of selected studies)

Cycle 4 of EBP

Implement useful findings (use evidence to make decisions on what assessment or intervention to use)

Cycle 5 of EBP

Evaluate the outcomes (reflect on practitioner and client’s experiences to make clinical decisions)

Subjective Burden

feelings of grief, loss of hope, feelings of exhaustion through long periods of time

Objective Burden of Caring

• More tangible

• Stressors of caring impacts family associated with the members illness

Cultural Barriers in Mental Health

• Cognitive

• Affective

• Values-related

• Physical or structural in nature

Family Resilience

• Building proactive and recovery factors

• Reduce environmental risks that threaten family

• Focus on strength-based approaches

Framework for Families & Mental Health:

• Family as central unit of attention

• Maximize options and choices

• Strength-focuses perspective

• Recovery – process of change to improve health and well-being (being the best version of self)

  • 4 dimensions: health, hope, purpose, and community

Family in Mental Health - Conceptualization

A dynamic social system composed of individuals whose patterns of occupations and interactions are interrelated

Person-centered

care requires collaboration

Collaboration

• is a process of mutual participation between the person and the practitioner and is a critical element in person centered care

  • This occurs within the context of a therapeutic relationship which requires therapeutic use of self

Therapeutic use of self

refers to the therapist’s “planned use of his or her personality, insights, perceptions and judgments as part of the therapeutic process”

Therapeutic Mode: Advocating

ensuring that the person’s rights are enforced and resources are secured, may require the practitioner to serve as a mediator, facilitator, negotiator, enforcer, or other type of advocate with external persons and agencies.

Therapeutic Mode: Collaborating

expecting the person to be an active and equal participant in therapy; ensuring choice, freedom, and autonomy to the greatest extent possible

Therapeutic Mode: Empathizing

• understand the person’s thoughts, feelings, and behaviors while suspending any judgment; ensuring the person verifies and experiences the practitioners understanding as truthful and validating

  • Significantly correlates to MOHOST  motivation and overall participation in rehab

Therapeutic Mode: Encouraging

seizing the opportunity to instill hope in a person; celebrating a person’s thinking or behavior through positive comments; conveying an attitude of joyfulness, playfulness, and confidence

Therapeutic Mode: Instructing

carefully structuring therapy activities and being explicit with people about the plan, sequence, and events of therapy; providing clear instruction and feedback about performance; setting limits on a person’s request or behavior as needed

Therapeutic Mode: Problem-solving

facilitating pragmatic thinking and solving dilemmas by outlining choices, posing strategic questions, and providing opportunities for comparative or analytical thinking.

Oppositional defiant disorder

• Pattern of defiance lasting at least 6 months by at least 4 symptoms

• Exhibited during an interaction with someone that isn’t a sibling

Intermittent Explosive Disorder

• Recurrent & represent failure to control aggressive impulses

  • Twice weekly for 3 months

  • 3 outburst  property damage or physical injury to another within 12 months

Conduct disorder:

Longstanding, violates rights of other and of social norms  little to no remorse for behavior

Antisocial personality disorder

• 18 years and older w/ history of symptoms of conduct behavior before 15 yrs old

  • Pattern of disregard for and violation of the rights of others

Pyromania

Deliberate and purposeful fire setting more than once

Kleptomania

Tension or anxiety that is relieved by stealing

Impacts on Occupational Performance

• Changing life roles require skills client might not have developed

• Unable to follow protocols

• Difficulty following societal rules —> legal issues —> incarceration

• ADLs

  • Self-care, day to day, sleep habits, etc

• Academics & employment

  • Requires ongoing support and development of self-management strategies

• Medication:

  • Proper dosage

  • Intended to help control and enable for better participation

  • Side effects

Leisure

autonomy, leisure competence, and social support

Play

framing, internal locus of control, intrinsic motivation, & freedom from the limits of reality

Affecting Factors Leisure & Play (1)

• Occupational balance

  • Disengagement

  • Partial engagement

Order doesn’t matter, disregard # (answer 1)

Affecting Factors Leisure & Play (2)

Flow

Order doesn’t matter, disregard # (answer 2)

Affecting Factors Leisure & Play (3)

• Occupational deprivation (can’t engage due to barriers)

  • Stigma

  • Symptoms

Order doesn’t matter, disregard #(answer3)

Affecting Factors Leisure & Play (4)

Occupational alienation (not allowed to engage)

Order doesn’t matter, disregard # (answer 4)

Importance of leisure activity and play participation

positive for mental health and mastery over environment

Assessments for Leisure & Play

• Free time boredom

• Leisure attitude measurement

• Leisure interest measure

• Leisure motivation scale

• Leisure satisfaction measure

• Activity card sort

• Modified interest checklist

Interventions for Leisure & Play in Children and Adolescents

o Small group activities

o Activity analysis

o Play based intervention for ADHD

o Activity scheduling

Interventions for Leisure & Play in Adults

o Social media

o Arts & craft

o Supported socialization

o Adjusting changing interests and abilities

Step 1 for Leading OT Group

• Introduction

• Set tone/ground rules

• Introduction & icebreaker

Step 2 for Leading OT Group

• Activity

  • Introduce sessions occupation

  • State length, target goals, and learning outcomes

Step 3 for Leading OT Group

• Sharing

  • Engagement

  • OT provides less structure in subsequent sessions

  • Group members provide feedback (mutual support)

  • OT models empathy and communication among members

Step 4 for Leading OT Group

• Processing

  • Encouragement to share feelings

  • Feedback to improve subsequent sessions

Step 5 for Leading OT Group

• Generalizing

  • OT leads in general principles from occupation, sharing, and processing

  • Therapeutic change

  • Group members communicate with each other not through OT

Step 6 for Leading OT Group

• Application

  • OT guides in exploring general principles

  • Focus on here and now and specificity

Step 7 for Leading OT Group

• Summary

  • OT invite group to participate in summarizing session

  • Focus on lessons learned during sharing, generalization, and application

Activity group

Build positive self-concept (improve communication among group members)

Task group

• Provide shared work experience

• Problem-solving – cognitive skills

• Complete task – end goal

Pyscho-education group

Mental health education

Social group

Develop social skills

Reminiscence group

Preserve memories of past experiences

Fall prevention

Fall safety & catch self

Leisure Group

Explore leisure activities

Functional Group

Purposeful actions

Additional Group Types

• sensory intervention group

• community & self-help group

Takeaways from OT Group Sessions

• client-centered

• Everyone must participate

• Flexible

• Enable and empower clients to target occupations

Democratic

• (participative): leader builds decision-making process.

  • Leader = resource person, participates in discussions

Autocratic

(authoritarian): leader makes decisions and gives directions (efficiency, structure, and guidance)

Laissez-faire

(delegative): leader provides supplies and needed information and leaves group alone.

Types of Research

• Descriptive

• Predictive

• Efficacy

• Assessment

• Qualitative

Occupational Balance

Every human seeks a variety of activities and occupations to meet his or her various occupational needs.

can only be defined subjectively, and similar patterns of activity may be experienced in significantly different ways by different people

Occupational justice

a derivative of social justice, refers to the right of every individual to have access to, and the ability to engage in, the variety of occupations necessary to support health and wellness

occupational deprivation

“the influence of an external circumstance that keeps a person from acquiring, using, or enjoying something”

Family Psychoeducation

Targets of Intervention Improving family relationships

Provides education and support to family members of an individual with a psychiatric condition.

Peer support programs

Targets of Intervention: Social connectedness and support

Education, socialization, and advocacy services provided by persons with a lived experience of mental illness.