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1. Learn about different types of stigmas and any real-life examples associated with them.

• 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

  • Emphasize opportunities for social role development

  • 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:

    • Discrimination

    • Social distance (excluding someone)

    • Poor parenting

    • Genetics

    • Substance abuse

  • Affects:

    • Negative impact on coping behaviors

    • Discrimination:

      • Housing

      • Education

      • Employment

• Stigma and Culture:

  • Stigma is universal and, in all cultures,

  • OTs need to understand:

    • 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:

    • 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 Interventions:

  • Anti-stigma programs

  • Education

  • Social contact

  • Advocacy

  • Public Stigma

    • Contact based education

  • Self-Stigma:

    • Narrative enhancement and cognitive therapy

    • Reduction programs

      • Pyscho-education

      • Cognitive-behavioral therapy

        • Improves negative self-appraisal

      • Motivational interviewing

      • Social skills training

      • Goal attainment

      • Music therapy:

• Stigma and Occupational Justice:

  • Universalism:

    • Marginality

    • Exclusion

    • Disaffiliation

  • Interventions:

    • 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

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• System in place designed to be inequitable

• Stigma attached to you

• Stigma-bias

1. Occupational profile and what is occupational performance and its analysis?

   1. Occupational Profile:

   2. Occupational Performance:

2. Know about evaluation and its process, what to consider, and the practice model

   1. Evaluation Process Steps:

      • Screen data to guide therapeutic reasoning

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

      • Choose assessments

        • Consider:

          1. Utility (quality of life)

          2. Validity (measure what intends to be measured)

          3. Reliability (consistency of measure)

      • Administer assessment

        • Obtain consent

        • Gather material

        • Establish rapport

      • Occupational profile

        • AOTA template structure

        • Identify occupational importance

      • Analyze occupational performance

      • Synthesize data and set goals

        • Specific

        • Measurable

        • Attainable

        • Relevant

        • Time

      • Reevaluate

        • Ongoing process

        • Measures outcomes

        • Is intervention effective?

        • Build body of evidence that supports occupational therapy

Takeaway: Evaluations are linear & client-centered

OT Process:

• Intervention

• Reevaluation

• Evidence-Based Practice in Mental Health

1. Learn about the assessment tools and how to select them

2. Different dimensions of wellness and examples and purpose of wellness inventory

• 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

• Role of Occupational Therapy:

  • Wellness lifestyle: balance of healthy lifestyle

  • Collaboration between the provide and individual in recovery

    • Holistic and client-centered approach

  • Health passport

    • Screening tool 🡪 mental illness & co-occurring illness

  • Health promoting lifestyle profile 2

    • Questionnaire

  • Wellness inventory

    • Likert scale 🡪 mental illness & substance abuse

THESE ARE STRATEGIES TO BUILD HEALHTY LIFESTLES

• Interventions for Wellness:

  • Spiritual dimension

  • Social dimension

  • Intellectual dimension

  • Emotional dimension

  • Occupational dimension

  • Environmental dimension

  • Financial dimension

1. Evidence-based practice and its cycle

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

   2. Principles of evidence-based medicine

   3. Cycle of EBP:

      • Identify the problem & ask a question (Why)

      • Identify the relevant evidence (use key words to search)

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

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

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

2. Types of burden-Objective vs Subjective

   1. Subjective Burden: feelings of grief, loss of hope, feelings of exhaustion through long periods of time

   2. Objective Burden of Caring: More tangible

      • Stressors of caring impacts family associated with the members illness

   3. Cultural Barriers in Mental Health:

      • Cognitive

      • Affective

      • Values-related

      • Physical or structural in nature

   4. Family Resilience:

      • Building proactive and recovery factors

      • Reduce environmental risks that threaten family

      • Focus on strength-based approaches

Takeaway: coping during life transitions, stress, or adversity

• Framework:

  • 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

1. Role of family in mental health and its conceptualization

   1. Conceptualization:

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

2. Terms such as family psychoeducation or support groups

3. Therapeutic use of self-Different types of communication with examples

   1. Person-centered care requires collaboration

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

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

   4. 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 Modes:

• 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.

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

• 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

• 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.

• 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

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

1. Different types of disruptive behavior disorders, their effects on different occupations, medication effects

   1. 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

   2. 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

   3. Conduct disorder:

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

        • Impairment in social, academic, or occupational functioning

   4. 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

   5. Pyromania:

      • Deliberate and purposeful fire setting more than once

   6. 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

1. Consequences of leisure activity and play participation

Exploration & Participation

• 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:

  • Occupational balance

    • Disengagement

    • Partial engagement

  • Flow

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

    • Stigma

    • Symptoms

  • Occupational alienation (not allowed to engage)

Takeaway: positive for mental health and mastery over environment

Assessments for Leisure & Play: (just know they exist)

• Free time boredom

• Leisure attitude measurement

• Leisure interest measure

• Leisure motivation scale

• Leisure satisfaction measure

• Activity card sort

• Modified interest checklist

Interventions:

• Children & adolescents:

  • Small group activities

  • Activity analysis

  • Play based intervention for ADHD

  • Activity scheduling

• Adults:

  • Social media

  • Arts & craft

  • Supported socialization

  • Adjusting changing interests and abilities

1. Understanding different terms such as occupational balance, justice, deprivation, etc.

2. How to run group sessions, lack of participation in groups, types of groups and leadership styles

   1. Leading OT Groups:

      • Step 1: Introduction

        • Set tone/ground rules

        • Introduction & icebreaker

      • Step 2: Activity

        • Introduce sessions occupation

        • State length, target goals, and learning outcomes

      • Step 3: Sharing

        • Engagement

        • OT provides less structure in subsequent sessions

        • Group members provide feedback (mutual support)

        • OT models empathy and communication among members

      • Step 4: Processing

        • Encouragement to share feelings

        • Feedback to improve subsequent sessions

      • Step 5: Generalizing

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

        • Therapeutic change

        • Group members communicate with each other not through OT

      • Step 6: Application

        • OT guides in exploring general principles

        • Focus on here and now and specificity

      • Step 7: Summary

        • OT invite group to participate in summarizing session

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

   2. Types of Groups:

      • 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

      • Sensory intervention

      • Pyscho-education group

        • Mental health education

      • Community & self-help group

      • Social group

        • Develop social skills

      • Reminiscence group

        • Preserve memories of past experiences

      • Fall prevention

        • Fall safety & catch self

      • Leisure

        • Explore leisure activities

      • Functional

        • Purposeful actions

Takeaway: client-centered

• Everyone must participate

• Flexible

• Enable and empower clients to target occupations

Leadership Styles:

• 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 research

• Predictive research

• Efficacy research

• Assessment research

• Qualitative research