New Directions in Occupational Therapy: Adolescent Mental Health

1
New Directions in Occupational TherapyAdolescent
Mental Health

• Amy Marshall, MS, OTR/L
• Doris Pierce, PhD, OTR/L, FAOTA
• KOTA 2005 Conference
• Paducah, Kentucky

2
Learning Objectives

• Understand characteristics of at-risk youth
• Understand the purpose and structure of PRISYM,
  Providing Rural Interdisciplinary Services to
  Youth with Mental Health Needs
• Recognize the contributions that occupational
  therapy brings to adolescent mental health

3
Definition of At-Risk Youth

• Youth who do not master the basic academic,
  vocational, social, and behavioral skills
  required to function successfully in school, the
  workplace, and the community.
• Most prevalent disabilities in alternative
  educational facilities
• learning disabilities
• emotional and behavioral disorders

4
Kentuckys Demographics
5
Kentucky

• Rates 42nd among states on child well-being (KYA,
  2005)
• 23 of 18-24 year-olds live in poverty (KYA,
  2002)
• 48.4 students are eligible for free or reduced
  lunch at school (KYA, 2002)
• 9.9 rural dropout rate is highest in the nation
  (National Center for Education Statistics, 2002)
• 42 out of the 51 of Appalachian counties in
  Kentucky are medically underserved (HRSA, 2003)

6
Disproportionate RepresentationKentucky
Department of Juvenile Justice, 2002

• Students identified with a disability in Kentucky
  public schools
• 16
• Students identified with a disability in Kentucky
  juvenile justice system
• 46

7

• Warehousing children in juvenile detention
  centers when they should be getting mental health
  treatment is a no-win situation. Weve got to
  get kids the help they need, so we can keep them
  out of jail (Bazelton Center for Mental Health
  Law, 2004).

8

• To serve 98,146 students with special needs,
  there were only 159 OTs in 1999-2000 (KY
  Department of Education, 2002)
• 66 of children and adolescents with emotional
  disturbance or mental illness do not receive
  treatment because of financial constraints, lack
  of knowledge about available resources, and
  stigma (Center for Mental Health Services, 2004)
• IDEA

9

• Students with an emotional disturbance have a
  dropout rate of 51 (US Department of Education,
  2001)

10
Interdisciplinary Practice

• Definition
• The complexity of services to developing
  adolescents with mental health needs requires
  health professionals with strong
  interdisciplinary and strong interagency skills
  (p 20 grant)

11
PRISYMProviding Rural Interdisciplinary Services
to Youth with Mental Health Needs

• 3-year grant funded by Health Resources and
  Services Administration (HRSA)
• Awarded to the Department of Occupational Therapy
  at Eastern Kentucky University
• Currently in Year 2 of the grant

12
Purpose

• To train occupational therapy, psychology, and
  social work students to work with rural youth
  with mental health needs

13
Purpose, cont.

• The project will create sustainable
  interdisciplinary training experiences in
  partnership with two rural community mental
  health service regions, in order to prepare
  graduates to provide culturally sensitive
  services to Appalachian youth.

14
Kentucky Department of Mental Health and Mental
Retardation Service Regions
15
Kentucky River Community Care Cumberland River
Comprehensive Care

• Both regions provide community-based mental
  health services for children and adolescents
• Services include school-based programs including
  alternative schools, parent advocacy groups,
  crisis clinics, community-based drug treatment
  programs, and residential care

16
PRISYM Plan of Study

• Fits into the last academic year of OT, social
  work, and psychology program
• Fall semester
• OTS 520/720 Providing Healthcare Services in
  Appalachia- Dr. Blakeney
• OTS 410/890 PRISYM Seminar I
• Spring semester
• OTS 410/890 PRISYM Seminar II
• Rural immersion experience

17
PRISYM Leadership Team

• Project Director, Dr. Doris Pierce Discipline
  Coordinators Research Coordinator Rural Partner
  Directors of Service KDMHMRS Representative
  Kentucky Partnership for Families and Children
  representative, youth advocate

18
PRISYM Evaluation

• Action Research Cycle will be used for continual
  improvement of PRISYMs effectiveness
• Outcomes Tracking Plan Initiate, track, and
  complete steps of traditional evaluation plan

19
Occupational Therapy and At-Risk Youth

• Understand typical and atypical patterns of time
  use, school function, behavior, recreation,
  social skills, and preparation for adult roles
• The knowledge base of OT is based on active doing
• Kentucky Department of Education Guidelines for
  Alternative Schools
• Active doing works best

20
Time Use and Leisure Occupations of Young
Offenders (Farnworth, 2000)

• Passive (timeout) vs. Active (achievement,
  social) occupations
• Enrichment and extracurricular activities not
  accessible to alternative school students
• Loss of leisure occupations of delinquent youth
  leads to loss of capacity (physical, cognitive,
  social skills), self-esteem, personal and worker
  identity

21
Doing, Being, and Boredom (Farnworth, 1998)

• Boredom experienced by youth more in situations
  of passive leisure, overload, lack of challenge
• Once out of the mainstream, many lose the
  habits, routines, and skills to engage in
  socially sanctioned occupations consequently,
  this lack of habits and routines, in which one
  can maintain and develop skills, impacts ones
  ability to undertake activities that one enjoys.
  This is interpreted as boredom.

22

• The occupational therapist engages the client
  around his or her occupations of interest and
  choice, not around the disorder, thus enabling
  the client to focus directly on recovery (Gray,
  2005).

23
Occupation Based Intervention
24
Appeal to Teens

• Client centered practice is a natural fit give
  the teen a choice
• Because the teen is making his/her own decisions,
  the buy in is easier
• This is their choice not yours

25
Balancing Collaboration Control

• Liberation
• Restrictive settings leads to boredom
• Giving choices
• Engaging
• Collaborative and continuous goal-setting
• Structure
• Adult in charge
• Clear rules
• Control over materials
• Building routines
• Choices within structure

26
Liberating Structures

• Challenging but successful
• Maximizing self-direction
• Therapist takes risks
• Chaotic-- but never boring!

27
Palette Program

• Based on 3 years of action research (Pierce,
  Fehringer, Marshall, Cunningham, 2003).

28
Occupational Palette

• Prevocational Skills
• Independent Living
• Healthy Leisure
• Underlying areas
• Competence
• Identity
• Social communication

29
Prevocational Skills
30
Independent Living Skills
31
Healthy Leisure
32
Discussion Questions

• References available upon request