Occupational Therapy for a Certified Community Behavioral Health Clinic: Needs Assessment Using Photovoice

PURPOSE: Service gaps exist between hospital-based care and productive community living for individuals with mental illness. Recently a federal initiative called for the development of Certified Community Behavioral Health Clinics (CCBHCs) that deliver innovative, well-coordinated, and evidence-based mental health and substance abuse treatment. Occupational therapists (OTs) are among the CCBHC staffing criteria. In response to this initiative, a CCBHC is under development, and a university–provider partnership was formed to design occupational therapy programs for the CCBHC. The purpose of this study was to assess occupational needs of community-dwelling adults who use behavioral health services. The research question was, What were the facilitating and hindering factors for engaging in meaningful activities for behavioral health service users?

DESIGN: Using the research design of Photovoice, a community-based participatory research approach, this study gave cameras to research participants to investigate issues of community living through their own lenses. Six participants were recruited using the following criteria: (1) had used inpatient or outpatient behavioral health services in the 6 mo prior to the study, (2) was age 18–65, (3) was capable of operating a digital camera, (4) was willing to commit to complete photo assignments and attend group meetings, and (5) felt comfortable participating in group discussions. Given limited resources, this study did not recruit non–English speakers.

METHOD: The participants completed three rounds of photo assignments and photo discussion meetings. Themes of the photo assignments were determined by the participants as a group, each getting deeper into the issues experienced. The SHOWED method was used to facilitate group discussions. NVivo 10.0 (QSR International, Doncaster, Victoria, Australia) was used to process both photo images and verbatim transcripts of group discussions. Transcripts were analyzed line by line (open coding) to identify themes of occupational needs. Axial and selective coding was used to identify facilitating and hindering factors of occupational engagement. A feedback meeting was held for member checking. Triangulation across researchers was sought during data analysis.

RESULTS: The resultant photo assignment themes were (1) people, places, and things that are meaningful to me; (2) internal and external obstacles that I face and work to overcome; and (3) bridges I need to help me transition from a safe environment to the real world. Results of preliminary data analysis revealed the following needs: lack of knowledge about mental illness and medications, lack of knowledge and skills to identify and engage in interests and hobbies to distract from mental illness, and loss of identity and life meaning. Features of needed services were identified as ongoing, non–crisis related, in both one-on-one and group forms, and with options of evening and weekend hours.

DISCUSSION: OTs may address these needs by providing psychoeducation to increase client health literacy related to mental illness and activity-based interventions to help clients identify and engage in meaningful occupations. OTs may also incorporate collaborative and participatory approaches to disseminate information on community resources, as well as strength-based approaches to enable clients to contribute their strengths to the community they live in.

CONCLUSION: Occupational therapists have a lot to offer in CCBHCs. To better address occupational needs of CCBHC clients, OTs need to incorporate and stay current on contemporary frames of reference besides providing traditional group and activity-based interventions. This needs assessment study serves as the first step of the university–provider partnership that aims to establish research evidence of adequacy for occupational therapy interventions in CCBHCs.