1. OT 624 Roles, Settings, and Communication

2. Adolescent and Adult Roles Role Theory:  MOHO uses the term, “role” to reflect how people view themselves and the multiple aspects of their life  Role Checklist  Worker Role Interview  Sociological and psychological views: roles = social positions  Social Construction versus personally enacted roles:  Society “constructs” roles through expectations  Controversy within the OT field about roles  Roles can overlap  Roles can be related to occupations  Roles need to be determined by the individual; yet, context is an important factor From: Crepeau, E. & Schell, B. (2009). Analyzing Occupations and Activity. (pp. 359-374). In Willard & Spackman’s occupational therapy (11 th ed.). (Crepeau, E., Cohn, E., & Schell, B., Eds.). Baltimore: Lippincott

3. Adolescent and Adult Roles We need to have our clients define their roles and not try to “fit” them into ones that we define Typical roles and typical occupations:  13-15?  18-22?  22-32  32-50 What do you project that you may experience related to roles and occupations with clients within the settings that you are assigned?

4. Community-based Practice It’s more than a geographic location It “includes an orientation to collective health, social priorities, and different modes of service provision”  (Scaffa, M. (2014). Community-based practice: Occupation in context. In Scaffa, M. & Reitz, S.M. (Eds.) Occupational therapy in community-based practice settings (2 nd ed.) Philadelphia: Davis, p. 4) Its models are based on individual and family needs throughout their communities It’s often started by communities leaders and/or members of a certain community that see a need  Examples: The Next Stop, Gateway, Project Search, Avita, Side by Side, Restore

5. Different Settings and Populations Early Intervention Community Mental Health Shelters Work/Vocational Programs Group Homes Senior Centers Criminal Justice Centers: Jail, Mental Health and/or Substance Abuse Programs Independent Living Centers Assistive Technology Centers Lifestyle Redesign http://www.youtube.com/watch?v=t9QJfnw40XY

6. Common Issues of Populations Commonalities of Population:  Cognitive Limitations  Executive Functions: A variety of skills which govern the bulk of cognitive processing which especially come into play during non- routine activity and generally govern and individual’s performance (Zoltan, 2007) Control and direction: planning, monitoring, activating, switching, inhibiting Behavioral self-regulation: able to self regulate in different situations; includes impulse control Volition: Self-awareness, initiation, motivation Purposeful action: translate intentions into a plan and performance

7. Common Issues of Population Executive Functions from occupation view (continued)  Initiation  Problem Solving  Mental flexibility  Concept formation or ability to do abstract reasoning  Categorization  Decision-making  Error correction

8. Communication Your role: Coach or Facilitator  “Sitting on hands”  Setting boundaries and limits  Making concrete statements when you need to be  Information shared in short pieces  Asking questions, not making directive statements  Encouragement  Reinforcement and validation regarding feelings and actions  Closely watch for sensory processing and modulation  Set up an environment that takes the person’s sensory processing into account  Know when to stop  Not viewing lack of performance as lack of motivation or the person being uncooperative

9. Common Fears “I’ll say the wrong (or stupid) thing!” “What if I don’t know what to say?” “What if I really upset the person?” “How will I handle it if the person becomes emotional?” “What if I need to interrupt the person because I need to see someone else?” “What if I say something and the person gets so upset that he or she commits suicide?” What does Robin always say to do when you don’t know what to say?  Acknowledge, acknowledge, acknowledge  Ask the person what he or she wants to do next

10. Suicide Breaking the myths:  People don’t cause other people to commit suicide  Nothing a person says is going to cause a person to commit suicide  People who are going to really commit suicide typically don’t tell others  A large percentage of people who are going to really commit suicide are happy and calm

11. Suicide Greater than 90% of people who die by suicide have the following risk factors:  Depression or other mental health disorder or substance abuse disorder  Feelings of hopelessness  Impulsive or aggressive tendencies or possibly problems with self- regulation  History of trauma or abuse  Some major physical illness  Previous suicide attempts or non-lethal self-injurious behaviors  Family history of suicide, mental health, or substance abuse disorders

12. Suicide If a person indicates to you that he or she is thinking of harming self or others, you must talk with your supervisor about this.  Tell the person that you have to do this  Never promise to keep secrets:  Tell people that what you discuss is confidential unless it is something that can be harmful to the person or others  Tell people that you are expected to report about the their progress during team meetings

13. Protective Factors Against Suicide Easy access to a variety of clinical interventions and ongoing support Effective clinical care with strong therapeutic alliances Restricted access to highly lethal means of suicide Strong connections to family and community Skills in problem solving and conflict resolution Cultural and religious beliefs that discourage suicide Defining thoughts and behaviors that precede self-injurious behavior Establishment of a support network and understanding of how to access crisis care National Institute of Mental Health (2008); Suicide Prevention Action Network (2001); Suicide Prevention Resource Center (2001) From: Champange, T. (2010). Occupational therapy in high-risk and special situations. In Steinholz, M. (Ed.). Occupational therapy in mental health. Bethesda, MD: AOTA