Thoughts on a BJOT article.

Hello readers and welcome to my first post of 2012!
 I'm so excited with what this year has to offer - January alone will see me moving away from home and starting my first Forensic OT post, eek! So what better way to start of this year of blogging than posting about a BJOT article on Forensic OT practice.

"An evaluation of the impact of a social inclusion programme on occupational functioning for forensic users." Martin Fitzgerald. BJOT Oct 2011 Vol. 74 No. 10

Within Occupational Therapy the rehabilitation of forensic service users with serious mental health illness is an emerging specialism with a relatively limited body of supporting evidence behind it. This article aims to, and succeeds, in providing evidence for, and to guide, practice for Forensic OTs working within rehabilitation settings.

UK governmental policy and Mental Health agendas have focuses on and require health and social care professionals to REDUCE DISCRIMINATION and SOCIAL EXCLUSION of service users.
The article argues that Occupational Therapists have the potential to fulfill the social inclusion expectancy in policy.

In 2006, the OT team for the Forensic and high Support Directorate (FHSD) within Pennine Care NHS Foundation trust set up a Social Inclusion Programme with the following aims:

"..to increase engagement in community-based activity; to introduce complex task performance and goal-orientated activity to treatment; to engage patients in normative learning environments; to improve literacy and numeracy skills; and to provide a stepping stone to further education and work."

The social inclusion programme was made available to all 62 service users in four long-stay units in the FHSD, a low-secure, rehabilitation forensic service at Pennine Care NHS Foundation Trust. The programme entailed graded community engagement and one-to-one goal planning with a unit-based occupational therapist, in addition to normal treatment. As prerequisite referral criteria for admission to the FHSD, all service users had a history of poor insight and poor engagement; more than half had a history of violence, 46% had an index offence and all were subject to the Mental Health Act (1983). The programme utilised grading and adapting to encourage service users to attend activities and to develop through the program skill hierarchy.
The purpose of the evaluation of the programme was to test for a difference in occupational functioning between service users attending the social inclusion programme and those following usual treatment. Occupational functioning of the two groups was measured using the Model of Human Occupation Screening Tool (MOHOST).

Results showed that little difference in overall MOHOST scores between the social interaction programme and those following treatment as usual before intervention and a significant difference in the scores of the social interaction programme group following intervention. This difference continued to be evident in four of the six subscales scores, with motivation for occupation, pattern of occupation, motor skills and environment all showing significant difference.

The study therefore shows that social inclusion work can improve occupational performance for forensic service users and, therefore, recommends it as an occupational therapy intervention for forensic services.

The article was a really interesting read and the outcomes are certainly encouraging for both my self and hopefully other OTs working within/interested in this field of Occupational Therapy. 

What really struck me about this article was the literature review, or more to the point, what it contained. 

Firstly this section explored how most serious mental illness has an average onset of late adolescence and early adulthood; resulting in the interruption of secondary and tertiary education. This interruption can impair the development of essential social skills, such as problem solving, time management, motivation and the use of initiative. Social exclusion experienced as stigma and the reduction of participation in relationships and mainstream social, cultural and economic activities, can often result from these impairments. 

it is therefore important, in my opinion, that Ots have an awareness of this and of the developmental stages which may have been effected and limited due to the onset of a serious mental illness. With this awareness and a full assessment process (which undoubtedly would occur) OTs would be able to fully address these impairments and help service users regain maximum occupational and social functioning. 

The second part which really struck me was the following few sentences:

"Preece (1995) argued that in forensic services the medical model contributes to the experience of occupational deprivation because it shapes the types of professional intervention that lead to underachievement, low motivation and low selfesteem. Underachievement and low expectation can further decrease the service user’s social networks and occupational opportunity which, in turn, increases the experience of social exclusion (Link et al 1989)."

The reason this struck a cord with me is because of some recent discussion about forensic OT I have had with some of my friends and family. So often in today's society I find that people are very quick to jump down the medical model of prescribing medication to fix everything. Although undeniable medication does have a positive effect on individuals with serious mental health illnesses, I do not think it is the only solution. As the article goes on to discuss an occupational perspective is needed to support and develop treatment approaches. Occupational Therapy should be a key part of rehabilitation.

As mentioned above, I found this article a really interesting and encouraging read and would recommend you reading it if you have access to the BJOT journals. I also hope that my ramblings make sense and have proven to be informative.

Kate