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 of 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: q Acknowledge 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 q This 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, or 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
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CONTI TINUED…. …. . q Facilitating the development of 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 q Statistically 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 q The 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 q The 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 q EMAS was developed to measure the extent of engagement in meaningful activities. It uses a self- rating Likert scale q Out of 14 participants 8 reported highly satisfied in engaging in meaningful activities. 5 reported moderate satisfaction and 2 reported low satisfaction q Correlation 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 ores s on on pe performanc nce and nd satisfaction sa on in Ca Canadian oc occupation onal th therapy pe performanc nce me measure
Patient Satisfaction Questionnaire scores X axis = No. of Questions 20 Y axis = Scores 18 16 14 Very Satisfied 12 Satisfied 10 Neither satisfied nor dissatisfied 8 Some what dissatisfied very dissatisfied 6 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 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 Th The combined results of Patient – Fa Family Satisfaction Sa on Question onnaire
The Comparison Of Pre And Post Scores On Performance ce And Satisfact ction In Canadian Occu ccupational Therapy Performance ce Measure 95% confidence COPM PRE POST ‘P’ VALUE interval of COMPONENTS difference 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 Engagement in Meaningful Activies Survey 2, 14% High Moderate 4, 29% 8, 57% Low
CO CORRELATION BETWEEN THE RAS & EMAS SCALE 70 60 60 56 55 50 50 47 𝑆 " Linear = 0.273 44 44 44 40 41 EMAS SCORE 39 35 34 34 30 20 21 EM 10 0 0 20 40 60 80 100 120 140 160 RAS 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
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