Applies theory regarding the therapeutic use of occupation and adaptation to screen and evaluate, plan, and implement intervention, while establishing and maintaining a therapeutic relationship with the client
Throughout my third fieldwork, I have been repeatedly turning to my Occupational Therapy in Mental Health (Brown & Stoffel, 2011) book to gain better insight into the theory that supports occupational engagement and adaptation in this setting. According to Brown and Stoffel (2011), the Person-Environment-Occupation Model is the most apt theory for this setting because when it comes to mental health, "the relationship of the components is dynamic" meaning they are "everchanging" and "transactive" (p. 43). In other words, people are complex and have a variety of factors that affect one another on a day-to-day basis and throughout the lifespan. When an individual is diagnosed with a mental illness or intellectual disability, that's one more layer of complexity added to that person's life. Working with this population is not always black-and-white due to number of complex factors affecting the individual's life. With this theory in the back of my mind, I have designed group protocols that address the use of occupation in everyday life while also implementing this theory when interacting one-on-one with clients. In addition, when evaluating clients, I chose to use the Occupational Circumstances Assessment Interview and Rating Scale (Forsyth, Deshpande, Kielhofner, Henriksson, Haglund, Olson et al., 2005), or OCAIRS, to gain better insight into an individual's mindset and habits to create an occupational profile. The OCAIRS is a preferred evaluation tool because it takes into account the person (his beliefs, temperament, strengths, weaknesses, etc.) as well as the environment (family situation, support groups, SES, etc.) and his occupations (daily schedule, roles, interests, etc.), which are all necessary for developing the occupational profile while also using theory to support it. This evaluation also allowed me to determine whether there was an imbalance in the client's life. For instance, one individual that I evaluated had a strong relationship with her parents and frequently did things with them, but she had no friends and had no desire in making friends. She stated that she had difficulty reading expressions and communicating with other people. She also added that she had previously had trouble with people at her previous job and that she was not currently interested in making friends. Based on this interview, I inferred that her difficulty with other employees at her previous job may have been due to her inability to read facial expressions, social cues, and appropriately engage with others. When I talked to my fieldwork educator afterwards about our client's difficulty with social cues she explained that individuals with schizophrenia have trouble reading facial expressions as well as difficulty reciprocating with appropriate tone and facial expressions. Since she struggled with her environment (i.e. the people), she would have difficulty performing purposeful activities and meaningful occupations (i.e. work and making friends). Now compound those difficulties with a mental illness, and she struggles to function on a daily basis due to the symptoms associated with the diagnosis, such as poor facial expression recognition, flat affect and monotone voice. And specifically in my client's case, add another layer of complexity with her intellectual disability. I personally feel this new facet requires an additional theory. Due to this individual's dual diagnosis of intellectual disability and schizophrenia, I would have to also use the Occupational Adaptation Model to improve the likelihood of her success when learning social skills. Nevertheless, this was an obvious imbalance in the client's life because it prevented her from building friendships outside of the home and ultimately prevented her from holding down a job due to her inability to interact with others in her environment. After this evaluation, the client and I were able to agree that she needed assistance to improve her social skills in order to manage a job in the future.