Short-Term Treatment in Occupational Therapy

Kathy Kaplan, Diane Gibson

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317735373
• Edition: 1
• Topic: Médecine
• Subtopic: Théorie, pratique et référence de la médecine

This volume discusses prime topics relevant to the practice of short -term psychiatric occupational therapy.

Short-Term Assessment: The Need and a Response

Kathy Kaplan, MS, OTR

ABSTRACT. Discharge planning usually starts on admission in the short-term setting. However, there are few evaluation strategies specifically designed for this purpose. Current psychiatry evaluations are reviewed, then an interview and rating scale is presented which has content validity and reasonably good inter-rater reliability. The instrument is based on the model of human occupation and expands the case analysis method. Research results are summarized and a case example is used to demonstrate the clinical utility of the procedure. Recommendations based on clinicians’ experiences with the instrument are discussed.

Evaluations in psychiatric occupational therapy are at an embryonic stage. In 1979, the American Occupational Therapy Association Annual Conference in Detroit held an institute on mental health evaluations. Three evaluations were presented and supported financially to continue reliability, validity, and normative development. In 1981, the American Occupational Therapy Association Mental Health Specialty Section compiled an index of 80 assessments used by occupational therapists in mental health (Moyer, Note 1). At the same time, 13 evaluations were reviewed and published by Hemphill (1982). The Bay Area Functional Performance Evaluation (BAFPE) is the only one of these instruments which has substantial supporting reliability, validity, and normative data.

The results of the 1983 Mental Health Special Interest Section Continuing Education Survey revealed the first of the top 12 topics which need to be addressed by continuing education programs is occupational therapy assessment in acute care. While occupational therapists generally recognize the importance of evaluations in clinical practice, they tend to adapt current instruments to meet the needs of their settings. “There are almost as many interest check lists as there are therapists” (Hemphill, 1982, p. 11). This trend reflects a lack of understanding of the importance of using tools which have been shown to be reliable and valid for a designated purpose and population.

One purpose and population for which evaluations are needed is discharge planning for the acute care adult psychiatric patient. The aim of discharge planning is to enable the client to prepare for return to home, or the expected environment, while still in the hospital (Spencer, 1978). During long-term psychiatric admissions, discharge preparation is important because the skills required to function in the hospital environment differ from those required outside of the hospital. While this distinction is also true in the short-term hospitalization, there is usually less of a danger of atrophy of skills (Gray, 1972) due to hospitalization because the length of time away from the original environment is minimal.

The main purpose of discharge planning in an acute care setting is to increase the relevance of the treatment process. Thus, discharge planning usually starts on admission. Optimally, the treatment team considers the inpatient’s occupation, life style, and social support system while developing the treatment plan (Dunning, 1972). The goal is to maximize the patient’s community adjustment.

While it is critical to begin discharge planning with the initial assessment of the short-term patient, the reasons for admission to the acute care unit frequently render the patient too confused, upset, or resistant to participate fully in an in-depth evaluation requiring paper and pencil response formats. Patients often are psychotic, suicidal, or withdrawing from drugs or alcohol when first admitted. Therefore, the initial occupational therapy assessment may include skilled observation in both structured groups and naturally occurring settings on the unit. As the patient increases in organization and capacity to reflect on the hospital experience, more formal and in-depth evaluation procedures can be used. It is generally recognized that patients are likely to be functioning at a higher level at discharge (Bloomer and Williams, 1978). In addition, their willingness to explore issues surrounding how they function in the community is usually greater than on admission.

Although discharge planning is a standard part of the ongoing evaluation and treatment process in psychiatric occupational therapy (Smith and Tiffany, 1978), there are few instruments currently available that are designed specifically for this purpose. The Kohl-man Evaluation of Living Skills (McGourty, 1979) is designed for discharge planning, but with a population which is generally older or more dysfunctional than the average adult short-term patient. Therefore, there is a need for an evaluation strategy specifically designed for the adult short-term psychiatric patient.

PROBLEM AND PURPOSE

In order to develop an occupational therapy evaluation that has scientific properties and which meets a gap in existing methods, one should consider reliability and validity methods, a theoretical framework for assessment, and the state of current instruments in occupational therapy. Because there is a dearth of reliable and valid instruments for the current practice of psychiatric occupational therapy, there is a critical need for clinically useful evaluation strategies with scientific properties. For the short-term patient, clinically useful means a practical procedure which is comprehensive yet efficient to administer. In this context, clinical utility means an evaluation which engages the patient in self-evaluation and planning and which focuses on components of a successful community adjustment.

The stresses of acute care settings often result in occupational therapists establishing their role by responding to the interests and demands of other staff members. Role blurring and eclecticism often emerge when there is little understanding of or support for the unique perspective of the occupational therapist. Therefore, evaluation strategies grounded in theory provide a conceptual tool for understanding the patient and a focus for the scope of practice.

The purpose of this paper is twofold: to summarize a review of the instruments designed for a psychiatric population and to present the case analysis interview and rating scale, an instrument which was developed to evaluate short-term psychiatric patients in the hospital setting in preparation for discharge. In the first part, a scheme is provided which organizes current psychiatric occupational therapy instruments by type and theoretical orientation. By critiquing the available instruments from the perspective of the needs for the short-term psychiatric setting, a context is provided in which to place the occupational case analysis interview and rating scale. In the second part, the instrument is presented to demonstrate efforts toward systematic development and clinical application. The instrument is based on the model of human occupation (Kielhofner and Burke, 1980) which provides a conceptual framework for examining the effects of psychiatric illness on adaptive function.

OCCUPATIONAL THERAPY INSTRUMENTS

Most occupational therapy instruments belong to one of six categories: performance evaluations, interviews, checklists, rating scales, questionnaires, or proj...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Editorial
• Introduction
• Short-Term Psychiatric Treatment: How Will Occupational Therapy Adapt?
• Changing Role Expectations of Psychiatric Occupational Therapists
• Short-Term Assessment: The Need and a Response
• The Use of Groups in Short-Term Psychiatric Settings
• Occupational Therapy for Chronic Pain: A Clinical Application of the Model of Human Occupation
• Short-Term Hospital Treatment of the Acute Schizophrenic Episode
• Theoretical Issues in Short-Term Treatment
• A Psychiatrist's Experience with Occupational Therapy in a Short-Term General Hospital Unit