Date Presented 04/19/21
OT is a treatment for acute psychiatric hospitalization in Taiwan, providing purposeful activities for patients with severe mental illness based on the Model of Human Occupation (MOHO) and the OT Practice Framework. Through in-depth interviews with staff, three key themes of OT services were identified: OT service challenges with MOHO, communication experience of OT services with team members, and a comprehensive index and continuity of treatment effects.
Primary Author and Speaker: Shu-Chun Lee
Additional Authors and Speakers: Yi-Ching Wu
Contributing Authors: David Leland Roberts, Kuang-Pei Tseng, and Wen-Yin Chen
PURPOSE: Occupational therapy (OT) services are a part of psychiatry in Taiwan National Health Insurance system. OT services are available to patients during acute/chronic hospitalization, as well as in daycare centers, community psychiatric rehabilitation centers, psychiatric nursing homes, and outpatient assessment/treatment facilities. Based on the Model of Human Occupation (MOHO), Occupational Therapy Practice Framework (OTPF), and International Classification of Functioning, Disability, and Health (ICF), OT practitioners use purposeful activities to help patients develop occupation adaptation, improve daily function, and maintain roles during acute hospitalization. OT services involve preparing a discharge plan with psychiatric team members. The purpose of this study is for OT practitioners to understand the expectations of OT services and develop MOHO-based services for people with severe mental illness.
DESIGN: Through content analysis of interview transcripts (in-depth interview with six main questions) from five members of the psychiatric staff. We invited and interviewed one psychiatrist, one registered professional nurse, and three OT practitioners to understand the expectations and practices of OT services during acute hospitalization.
METHOD: We interviewed, recorded, and wrote verbatim. Respondents had over 7 years of clinical experience in psychiatry which included at least 2 years of acute psychiatric inpatient services. They were members of the psychiatric team and had experience communicating for discharge planning. We designed six interview questions: (1) What are the problems and needs of patients with acute hospitalized mental illness? (2) What can an OT practitioner do to assist in acute mental illness? (3) For psychiatrist/registered professional nurse, what is the treatment model for patients with acute hospitalized mental illness? What is the evidence basis? (4) What is the effect after discharge from medical treatment for patients with acute mental illness? (5) What is your opinion on the application of MOHO, ICF, and OTPF for patients with acute mental illness? (6) How would you use MOHO, ICF, and OTPF in OT for patients with acute mental illness? All interviews were recorded and a verbatim draft record was produced. Then, two senior OT practitioners read the transcripts and wrote down their keynotes to induce the common themes.
RESULTS: Twelve content keynotes were initially derived. These were: (1) the disturbance of psychotic symptoms and the burden of family; (2) the need for treatment to prevent relapses of the disease; (3) observation and evaluation of usefulness of OT; (4) OT services were necessary; (5) ICF and OTPF-3 were helpful for evaluation; (6) MOHO theory helped in setting treatment goals; (7) ICF was the common language for team members; (8) through MOHO theory, advantages and disadvantages of the patients can be obtained; (9) the bio-psychosocial model for psychiatric rehabilitation; (10) few evidence-based psychiatric rehabilitation; (11) half admission was effective; and (12) comprehensive treatment index. Finally, three themes were identified: (1) OT services challenges with MOHO theory, (2) communication experience of OT services with team members, and (3) comprehensive index and continuity of treatment effects.
CONCLUSION: This content analysis illustrates how in-depth interviews may help OT practitioners understand the expectations of OT services of other professionals. Additionally, this information communicated between the teams helped the OT practitioners develop a more appropriate treatment model for patients with mental illness during acute hospitalization. Thus, the OT service model has two advantages, a theoretical OT service model and more appropriate discharge plans.
References
Shimada T, Ohori M, Inagaki Y, Shimooka Y, Sugimura N, Ishihara I, et al. (2018) A multicenter, randomized controlled trial of individualized occupational therapy for patients with schizophrenia in Japan. PLoS ONE 13(4): e0193869. https://doi.org/10.1371/journal.pone.0193869
Lipskaya-Velikovsky, L., Krupa, T., Silvan-Kosovich, I., & Kotler, M. (2020). Occupation-focused intervention for in-patient mental health settings: pilot study of effectiveness. Journal of psychiatric research. https://doi.org/10.1016/j.jpsychires.2020.03.004
Larsson-Lund, M., & Nyman, A. (2017). Participation and occupation in occupational therapy models of practice: a discussion of possibilities and challenges. Scandinavian journal of occupational therapy, 24(6), 393-397. https://doi.org/10.1080/11038128.2016.1267257
