Occupational Connections (OC)—A Participation-Oriented,Short-Term Intervention for Inpatient Psychiatry Settings: Effectiveness Study

PURPOSE: Mental health conditions (MHC) have been associated with participation and occupational restrictions. Despite the fact that many people with MHC receive services in in-patient mental health settings, there is little evidence for in-patient, occupation-based interventions intended to support community-based participation, health, and well-being. This study investigated the effectiveness of “Occupational Connections (OC), a short-term, structured intervention for the inpatient setting.

DESIGN: This is a quasi-experimental, prospective, pre-post designed study with convenience sampling. A naturalistic study design guided participants’ enrolment and intervention duration to meet the realities of in-patient practice.

METHODS: Using a structured, cyclical group format and a collaborative approach, OC encourages individuals to develop an understanding of the link between occupation, well-being and recovery, and addresses participation personal issues from a personal, occupational and environmental perspective during hospitalization. The intervention is meant to contribute to the in-patient experience of the setting as recovery promoting.

Thirty-three in-patients with schizophrenia were enrolled in the study: 16 participants (aged 34.4 (±8.9), with illness duration of 11 (±7.6) years) took part in the OC intervention in addition to treatment as usual (TAU) as the study group; and 17 participants (aged 33(±9.3), with illness duration of 9 (±6) years) received TAU only (control group). All the participants completed evaluations at baseline and at discharge or after 10 weeks, the earlier among them. The outcome measures were: Intention for Participation Scale for assessment of intention to participate in activities after discharge; Impact on Participation and Autonomy questionnaire for evaluation of autonomy experienced in participation; Recovery Self Assessment for personal estimation of provided hospital services as recovery oriented. The following measurements were completed to obtain descriptive information: Neuro-Cognitive State Examination, Trail Making Test, Ray Complex Figure, and Category Fluency Test for different aspects of cognition; Positive and Negative Syndrome Scale for symptoms severity, Observed Tasks of Daily Living for functional capacity, and Adults Subjective Assessment of Participation for participation dimensions. Changes from the baseline to the end of the study in descriptive and outcome measures were estimated using Paired t-test or Wilcoxon test depends on the distribution of the data in each group.

RESULTS: Significant differences between the groups at the base were only found in the number of hospital admissions and participation diversity. The intention for participation and perception of services as recovery oriented (primary outcomes) were significantly improved in the study group (2.6<t<3.15, p<.05). Significant improvement in cognitive functioning, symptom severity, functional capacity and participation diversity was found in the study group after the intervention (2.1<t<10.74, p<.05). These changes were not observed in the control group.

CONCLUSION: The results provide initial evidence for the potential of OC to contribute to the delivery of participation-promoting, recovery-oriented interventions in the inpatient setting. In addition, OC contributes to improvement in personal factors and functional capacity which are enablers for participation, further supporting the OC effectiveness. As OC was developed and delivered by OTs, the study provides additional evidence for the OT unique knowledge and skills related to promoting occupational participation and recovery in the mental health field. Further research is needed to strengthen the evidence for the effectiveness of the OC.

References

Krupa, T., Kirsh, B., Pitts, D., & Fossey, E. (Eds.). (2016). Bruce and Borg’s psychosocial frames of reference: Theories, models and approaches for occupation-based practice (4th ed.). Thorofare, NJ: Slack.

Edgelow, M. and Krupa, T. (2011). A Randomized Controlled Pilot Study of an Occupational Time Use Intervention for People with Serious Mental Illness. American Journal of Occupational Therapy, 65, 267-276. doi:10.5014/ajot.2011.001313

Lipskaya-Velikovsky, L., Jarus, T., & Kotler, M. (2017). Prediction of the intensity and diversity of day-to-day activities among people with schizophrenia using parameters obtained during acute hospitalization. Disability and Rehabilitation, 39(13), 1300-1306. doi:10.1080/09638288.2016.1194896

Lipskaya-Velikovsky, L., Kotler, M., & Krupa, T. (2016). Description of and preliminary findings for Occupational Connections, an intervention for inpatient psychiatry settings. American Journal of Occupational Therapy, 70(6), 1-5. doi:10.5014/ajot.2016.014688