OTs and transitions

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OTs and Occupational Transitions

OTs can work with people in transition:  new parents, those planning for or entering retirement, transitions from incarceration to independent living, and transitions from high school to university (to name just a few!).   There is a great book called Transitions Across the Lifespan:  An Occupational Therapy Approach (edited by Meira L. Orentlicher, Sandra, Schefkind, and Robert W. Gibson) for those of you who are interested in more information about OTs role in this area.  However, the book focuses mostly on the transitions that are already embedded in OT practice (early childhood transitions, transitions to university and working life for adolescents with disabilities, and health care transitions).

Health promotion during transitions

OTs have a lot to offer when it comes to health promotion during transitions.  I focus on the transition from hight school to university because it is an area that I have a lot of interest, but I think transition programs can work well in many populations (those nearing retirement, new parents, etc). I focus on promotion of mental health  through occupational balance and good lifestyle choices (see AOTAs statement on promotion of mental health here).

The program that I developed isn’t a new concept – it follows some of the same concepts that are found in the Well Elderly Study – that engagement in meaningful occupations appropriate to life stage can be life-enhancing.  USC has also been providing the Lifestyle Redesign® program to their student population for years.  At USC, occupational therapists complete an assessment with current students and work on areas of life where students are most struggling.

My program has been modified from its original version (after providing it to multiple groups of students) and is slightly different from other transition programs since all the students who sign up for the program begin their OT journey by participating in the entire 5 module program in a group setting.  There is individualization of the course content at the group level – basically, the group leader uses the students experiences and interest in each area to guide discussion and help problem-solve current issues in the participants’ lives.

Why do you make all the students participate in all the modules?

Insight of university students:  There is some question about the ability of university students (especially those in their first or second year) to identify where they are struggling in an area of function (there is definitely a lot of variability – depending on maturity and life experience).  In my opinion, a group environment that is provided over an extended period of time can also elicit information about the student to guide intervention that might not otherwise be shared in a traditional clinician-client interaction.

General health knowledge: The group environment gives the students a chance to learn about different aspects of health  and how it pertains to their own areas of occupation and overall occupational balance.  The information that is provided is not always intuitive or known (even by OTs – see my blog on sleep and rest, one of the areas we cover in our groups).  I have found that even if the specific health knowledge is known by the students, the group gives them some practice applying the information and reflecting on it.

Social participation: The group format provides a secondary benefit for the participants:  the chance to meet new friends.  In many studies about university students, it is NOT the academics that rise to the top of their list of concerns – it is the social aspect of university and social participation that concerns most students.

Why don’t you focus on a specific population of students?

What I have found is that there are a lot of students who may be “unidentified” by the system, but they may need to be “identified” to receive the support they need for a successful transition.  The vast majority of students WILL NOT “identify” themselves for services. In fact, recent estimates state that only about 10% of students who need help will look for it.  And, the rate of university dropout due to mental health concerns is alarming (1)(2).

I take a health promotion approach  since there are students who participate in the program who may only learn one thing, but there are others who find that much of the information is “new to them”.   Finally, there are others who can benefit from more intensive services and I can use the program as a referral mechanism (again, because a lot of these students won’t seek help on their own!)

How is the program conducted?

The program focuses on areas of occupation (general self care, sleep/rest, IADLs – time management, social participation, and leisure).

Students go through an intake assessment so that the group leaders can understand the needs and concerns of each participant.  They are then assigned a group based on their availability.  Students are assigned to small groups (of no more than 8 per group) meeting once per month for five months.  A different topic is presented every month – using Cole’s 7 stages of a group as a guide.  The students receive “homework” relevant to each topic area.  The “homework” is reviewed as part of the introduction each month and provides the students with real-world application of their learning.

On the last day of the group, the students are challenged to use their new-found knowledge to set-up a life plan for themselves.  They also make goals that will help keep them on track.  The group leader provides the participants with certificates of completion and meets with each of them individually to provides some recommendations.  The recommendations might include encouragement about what is going well and discussion about what further services or strategies might be beneficial for them.

The original pilot study was published in OT in Mental Health in April 2016 (3).   Students who participated in the program saw an improvement in their self-identified areas of occupation (using the COPM) and their satisfaction with their performance in self-identified occupations.  The long-term follow-up was also published (access it online here).

I would love to hear about your own programs or your thoughts about being an OT working with people to improve their health by promoting good lifestyle choices!

References

(1)Conley, C. S., Travers, L. V., & Bryant, F. B. (2013). Promoting psychosocial adjustment and stress management in first-year college students: The benefits of engagement in a psychosocial wellness seminar. Journal of American College Health, 61(2). 75-86.

(2)Wynaden, D., Wichmann, H., & Murray, S. (2013).  A synopsis of the mental health concerns of university students: Results of a text-based online survey from one Australian university.  Higher Education Research & Development, 32(5), 846-860, doi:  10.1080/07294360.2013.777032

(3)Keptner,K., Harris,A., Mellyn,J., Neff,N., Rassie,N., & Thompson,K. (2016) Occupational therapy services to promote occupational performance, performance satisfaction,and quality of life in university freshmen: A pilot study. Occupational Therapy in Mental Health, 32(2), 185-202. doi:10.1080/0164212X.2015.1135094.

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