Date Presented 03/26/20
This presentation reports outcomes of a program designed for adults with substance-abuse disorder living in supported housing. Interventions stressed practical competencies and building functional habits and routines, including self-directed goal setting, to support participants’ recovery and capacity to transition to independent community housing. Collaboration with case managers and housing specialists enhanced outcomes and simultaneously built evidence for the distinct value of OT interventions.
Primary Author and Speaker: YiNao Wang
Additional Authors and Speakers: Jaime Muñoz
Contributing Authors: Rev. Kellie Wild, John McCartin
PURPOSE: This study assessed program outcomes. The program sought to improve role functioning, time management and self-directed goal setting to support recovery and community integration for men with substance use disorder (SUD) in a supported housing (SH) program. SUD is a major societal issue linked with social determinants of health such as homelessness, poverty, unemployment and incarceration (1). In 2016, 20 million people were diagnosed with SUD; many present a profile including chronic mental and medical conditions (1,2). Profiles of multimorbidity make recovery difficult and keep relapse rates high (2). Keeping functional routines helps people with SUD to find, get and keep a job, training, or housing and building prosocial habits helps them maintain recovery and engage their community (3,4).
DESIGN: A multiple case study design used mixed methods of data collection to discover if changes in the time use and establishing new routines support people with SUD to learn competencies and improve role functioning to support independent community living. A convenience sampling strategy included 6 adult men with SUD from one SH program.
METHOD: Demographic data were collected. The Kawa Model process was used to visualize occupational, vocational, educational, criminal justice and substance use histories and these data were analyzed descriptively to define and compare life trajectories and patterns of role functioning. Occupational profiles were developed using the Occupational Circumstances Assessment Interview & Rating Scale and Role Checklist v3, completed at intake and discharge. Time use was tracked using time logs. Time spent in specific activity categories was calculated at intake and at 2-week intervals until d/c. Goal Attainment Scaling was used as an overarching framework to focus intervention and included goal analysis processes to define specific bi-weekly tasks to complete. Task checklists derived from these processes were completed, tracked and reviewed in individual sessions.
RESULTS: The participants had a mean age of 41.6. Most reported abusing substances early, a MH diagnosis, poor education and employment histories, and incarceration. Collectively, OCAIRS ratings reflected performances inhibited by individual and environmental factors. On admission these men identified few current roles but were able to prioritize future role participation. Time-log data initially reflected significant time spent sleeping and in passive activity. Most men showed clear improvement in time spent in active leisure, productive occupations and ADL/IADLs. For men with at least 3 weeks of GAS scores, these reflected goal attainment with employment, maintenance and housing goals reflecting the most positive changes. Task completion using goal analysis checklists reflected the highest follow thru for tasks related to employment and the lowest follow thru for steps related to securing housing. Data from 4 participants with the most complete data will be presented as individual cases and one composite case story.
CONCLUSION: A program emphasizing self-directed goals setting and habit training improved the ability of participants to identify meaningful roles, enhanced time management, increased participation in productive and active leisure occupations and was successful in reducing the impact of some personal and environmental barriers inhibiting occupational performances.
IMPACT STATEMENT: The results of this pilot study show the effectiveness of a habituation focused OT program that demonstrates the distinct value of OT’s role in SH programs with people who present a myriad of performance challenges. Approaches employed in this study may inform others as they design, advocate, and develop OT services in community-based settings.
References
Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSDUH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www. samhsa.gov/data/
Manuel, J. I., Yuan, Y., Herman, D. B., Svikis, D. S., Nichols, O., Palmer, E., & Deren, S. (2017). Barriers and facilitators to successful transition from long-term residential substance abuse treatment. Journal of Substance Abuse Treatment, 74, 16-22. doi: 10.1016/j.jsat.2016.12.001
LePage, J. P., & Garcia-Rea, E. A. (2012). Lifestyle coaching’s effect on 6-month follow-up in recently homeless substance dependent veterans: a randomized study. Psychiatric Rehabilitation Journal, 35(5), 396-402. doi:10.1037/h0094500
Edgelow, M., & Krupa, T. (2011). Randomized controlled pilot study of an occupational time-use intervention for people with serious mental illness. American Journal of Occupational Therapy, 65(3), 267-276. doi: https://doi.org/10.5014/ajot.2011.001313
