Mental Health Promotion, Prevention, and Intervention in Practice Claudette Fette, PhD, OTR, CRC

AOTA Official Documents

AOTA Statements

Mental Health Promotion, Prevention, and Intervention in Occupational Therapy Practice, 2017 Occupational therapy’s role Education and qualifications Core mental health skills applied to OT practice Occupational therapy process in mental health Case studies Evaluation Intervention, Promotion, and Prevention Strategies Outcomes Promote participation - Focus on what they want and need to do

More AOTA Resources; Practice Guidelines, Distinct Value

Children & Youth

OT Practice Guidelines for Mental Health Promotion, Prevention, and Intervention for Children and Youth Sue Bazyk, PhD, OTR/L, FAOTA Marian Arbesman, PhD, OTR/L oT PG for Children & Youth follows a Public Health Model … focus is on promotion of occupational performance at all 3 tiers OT domain and process guide the promotion of occupational performance which results from dynamic interaction between client/ context /occupation – p 15 OT uses task analysis to align relationship of person /environment /occupation with emphasis on competency enhancement and use of meaningful occupation – p16

Types of Services Promotion – learning how to become mentally healthy competence enhancement mental health literacy skill building & strength-based approaches Prevention: reduction of risks Tuning into at-risk groups – ‘loners’, children who are obese, live in poverty, those with disabilities Intensive, Individualized – Systems of Care Wrap-around; Behavioral Intervention Plans, etc. MH promotion focuses on competence enhancement – building strengths and resources in the whole population – p 18 MH prevention focuses primarily on reducing risk factors and enhancing protective factors – p 18 At each tier, PG lays out 1) Knowledge needed, 2) Evaluation 3) EB Intervention Intensive interventions diminish the effects of identified MH px & seek to restore optiman functioning

Public Health Approach to SMH shifts from individually focused to school-wide; from deficit driven to strength-based; emphasis on early intervention & prevention Tier 3  Tier 2  Tier 1  3 – 1-5% 2 – 5-15% 1 – 80-90%

Let’s begin with ‘mental health’ What it isn’t? MENTAL HEALTH is not the absence of MENTAL ILLNESS Sue Bazyk Mental health is: Positive affective or emotional state (feeling happy) Positive psychological and social function (self esteem/ control, relationships) Productive activities Resilience – coping with challenges

Raising children … is vastly more than fixing what is wrong with them. It is about identifying and nurturing their strongest qualities, what they own and are best at, and helping them find niches in which they can best live out these strengths. Seligman & Csikzentmihalyi, 2000, p. 6 Opening statement in introduction

Tier 1 Universal Services Focus on all children Need for system change Caseload to Workload PBIS - Multi-tiered Systems of Support SEL – CASEL 8 key features of contexts that promote positive youth development Safety Structure Relationships Belonging Positive social norms Efficacy and mattering Skill building Integration of family, school & community

Tier 1 Universal Services Strong evidence for social skills programs Moderate to strong evidence for use of play, recreation or leisure programs Positive outcomes with focus on health promotion Every Moment Counts http://www.everymomentcounts.org/ Strong evidence for social skills programs ---- to increase Social Emotional functioning and decrease px behavior Moderate to strong evidence for use of play, recreation or leisure programs ----- to increase social competence and peer interaction Positive outcomes with focus on health promotion eg stress mgmt, health literacy, yoga

Tier 2 Targeted Interventions Children/youth at risk OT background in psychopathology and social participation Consultation/modification of environment, activity groups At risk = Children with ID, disability, prodromal symptoms … need to know early signs of metal illnesses

Tier 2 Targeted Interventions School Activity based social skills group with decreased peer interaction or problem behaviors Social skills programming for youth with ADHD or LD Embed yoga, relaxation strategies Facilitate play, recreation, leisure Early intervening and 504 plans, teacher consultation Psychoeducation inservices, parent education Knowledge --- learn early signs of MI, Know early intervention strategies Evaluation tools Intervention … above

Tier 2 Targeted Interventions Community Know benefit of structured leisure and share Evaluate opportunities in community Interventions – visit settings and build opportunities, develop resource guide Knowledge --- Know early intervention strategies Evaluation tools Intervention

Tier 3 Intensive Interventions For youth with identified mental, emotional or behavioral disorders SED affect 5-9% and result in impaired daily function in home, school and community. For youth with disabilities, rate is 11.5%, and only 42% of those receive mental health services. 70-80% percent of those needing mental health services do not receive them. p 50 When targeted interventions are not meeting the needs of the student, and behaviors are disruptive, dangerous or prevent learning. At intensive level, person-occupation-environment transaction requires in depth knowledge of range of MH & behavioral disorders

Tier 3 Intensive Interventions Begin with FBA … drives BIP Subjective wellbeing and occupational justice Evidence for cognitive behavioral approach (includes psychoeducation, reframing, relaxation) social skills, intensive play/leisure/recreation Accommodations and supports for symptoms, performance effects at school/work Maintain focus on ID/building strengths and fostering engagement in occupation Again, Broken down into: Knowledge Evaluation – FBA Intervention Know typical symptoms for thought disorders, mood do, anxiety do, and ways to build coping strategies + manage environment to enable success

Tier 3 Intensive Interventions Promote development of individual interests in school and community Analyze sensory, cognitive and psychosocial needs Collaborate with school team, in community to build comprehensive system of care; with teachers to modify classroom Modify/enhance routines, provide tips to promote success Group interventions for social participation/leisure Psychoeducation regarding prodromal symptoms, CBT, social skills, proactive/strength-based prevention

Preparation and Qualifications of OTs and COTAs OT Practice Guidelines for Mental Health Promotion, Prevention, and Intervention for Children and Youth Appendixes: Preparation and Qualifications of OTs and COTAs Evidence –Based Practice Evidence Tables Supplementary information Sue Bazyk, PhD, OTR/L, FAOTA Marian Arbesman, PhD, OTR/L

OT Practice Guidelines for Adults with Serious Mental Illness Catana Brown, PhD, OTR, FAOTA

Recovery Self direction Individual and Person Centered Empowerment Holistic Nonlinear Strengths-based Peer support Respect Responsibility Hope Core principles Consistent with occupation based practice Self direction – person is primary decision maker Individual and Person Centered – each person’s recovery is unique Empowerment – person maintains control over their destiny Holistic – recovery involves all aspects of one’s life … physical, mental , spiritual Nonlinear – recovery is not a strait line … setbacks often result in positive learning Strengths-based – not impairment focused, capitalizes on individual strengths Peer support Respect – accept and appreciate, foster self acceptance Responsibility Hope

OTPF Domain & Process Discuss domain and process

Occupational Therapy Process Referral Evaluation Occupational Profile Analysis of Occupational Performance Occupations Performance skills, client factors, performance patterns Contexts/environments, activity demands Interpretation Intervention Plan & Process

Evidence Based Interventions General (related to areas of occupation) Supported employment or individual place & support (IPS) models (A) Lifestyle interventions to improve health behaviors related to obesity and metabolic syndrome (A) Supported education programs (B) Skills training plus health care management (B) Physical activity, exercise, and outdoor activities to improve symptoms of depression and anxiety (B) A Strong recommendation B recommended

Evidence Based Interventions Performance Skills Cognitive remediation to improve life skills tied to real life practice (B) Cognitive skills training in conjunction with supported employment (B) Social cognition and problem solving training (B) Cognitive training to improve cognitive skills (B) Emotional regulation and social skills training in conjunction with supported employment (B)

Evidence Based Interventions Performance Patterns Context & Environment Environmental supports improve adaptive functioning (A) Cooking skills in both clinic and home (B) Routines Interpersonal and social rhythm therapy to establish and maintain routines for people with bipolar d/o (B) Activity Demands Use of work behavior inventory to provide work related feedback in combination with supported employment (B)

OT Practice Guidelines for Adults with Serious Mental Illness Appendixes: Preparation and Qualifications of OTs and COTAs Evidence –Based Practice Evidence Tables Resources for Recovery Oriented Practice Catana Brown, PhD, OTR, FAOTA

Questions? cfette@twu.edu