Occupational therapy and clinical research in mental health rehabilitation

Practitioners working in Australian mental health services are faced with the challenge of providing appropriate evidence-based interventions that lead to measurable improvement and good outcomes. Current government policy is committed to the development of strategic mental health research. One focus has been on under-researched practice areas, which include the development of psychosocial rehabilitation systems and models that facilitate recovery. To meet this challenge, an Australian rehabilitation service formed a collaborative partnership with a university. The purposes of the collaboration were to implement new forms of service delivery based on consumer need and evidence and to design research projects to evaluate components of the rehabilitation programme. This article examines the process of developing the collaboration and provides examples of how research projects have been used to inform practice and improve the effectiveness of service delivery. Challenges to the sustainability of this kind of collaboration are considered.

An organizational perspective on goal setting in community-based brain injury rehabilitation

Purpose. To use a taxonomy of goal content, developed in community-based brain injury rehabilitation to examine and compare the content of goals set within two different service settings; and to further examine the potential of the taxonomy to be a reliable and comprehensive framework for classifying goals. Method. Qualitative analysis and categorization of 1492 goal statements extracted from a community-based brain injury rehabilitation service over two time periods (1996-97, 1998-99), and cross-organizational comparison of ratings of goal classifications using a random sample of 100 goal statements drawn from this data set and the original 1765 goal statements used in developing the taxonomy. Results. Application of the taxonomy beyond the original service setting in which it was developed indicated a strong inter-rater reliability, with a high test-retest agreement reported over time. For both services, a small number of categories accounted for a substantial proportion of goals set within the two time periods, while considerable change was evident in goals between the two periods for one service. Further, both placed emphasis on individually focused goals rather than relationship or family-related goals. Conclusion. The taxonomy provides a reliable means for classifying goals and is a useful tool for exploration of the multiple influences on goal setting. Further application of the taxonomy to examine the relative influence on goal setting of client factors versus a range of organizational factors would be beneficial.

NEW Solutions: An Australian health promotion programme for people with mental illness

The prevalence of people who are overweight or obese is continuing to rise. This is a key risk indicator of preventable morbidity and mortality resulting from many diseases. The increase in the number of obese people is associated with dietary practices and a reduction in physical activity. There is a need to implement strategies for the reduction of obesity in at-risk groups. People with a mental illness are at high risk of many physical illnesses related to behavioural factors, which include poor diet and lack of exercise. Health promotion programmes need to be incorporated into mental-health services to improve the general health and wellbeing of people with a mental illness. An Australian psychiatric rehabilitation service developed and implemented a health promotion programme, NEW Solutions, which aimed to address issues related to weight gain, dietary practice and physical inactivity.

Food Cent$: Educating mothers with a mental illness about nutrition

People with a mental illness can have deficits in a range of areas, including food skills. Mothers who have a mental illness and have residential care of their children are particularly vulnerable to experiencing food insecurity. The food skills programme known as Food Cent$ is a new way of spending money on food using the 10-plan, so that people can learn to balance their diet and their food budget. Occupational therapists in a mental health rehabilitation service incorporated the use of Food Cent$ into a parenting programme for mothers with a mental illness. A pilot study was conducted to identify whether the Food Cent$ programme influenced behaviours and attitudes towards food and food selection and preparation and reduced grocery expenditure. The participants were six mothers with a mental illness who had children under 5 years of age in their care. A focus group was conducted to gain insight into the experiences of mothers who had attended the programme. Supermarket receipts were collected before and after the project to determine changes in dietary practices. The results indicated that attending Food Cent$ contributed to an improvement in dietary intake, food selection and preparation, and grocery expenditure. Further research is required into the effectiveness of this programme with other target groups likely to experience food insecurity.

Partnerships in mental health: Addressing barriers to social inclusion

Current trends in mental health services emphasize working in partnership with consumers and other government and non-government community organizations for improvement in quality of life for service users. People with a mental illness experience social exclusion, thereby limiting their ability to participate fully in community life. Occupational therapists have a substantial role to play in helping service users to overcome barriers to their community inclusion. Partnerships need to be formed to increase access to community resources and participation in activities that are enjoyed by other members of the community. Such partnerships have a health promotion emphasis and foster the relationship between mental-health services and the wider community, thus shifting the focus from direct occupational therapy service delivery to community-based rehabilitation interventions.This article describes the development, implementation and evaluation of an Australian healthy lifestyle course devised to meet the identified rehabilitation goals of people with mental illness to lose weight, get fit, commence vocational study and get a job. The course was run in partnership between mental health consumers, occupational therapists from the St George Mental Health Rehabilitation Service and staff and students from the Sutherland College of Technical and Further Education.

Kick'n'On: Helping young males kick back into life

Young men with psychotic disorders have persistently poorer outcomes in social functioning when interventions aimed at arresting social isolation are not implemented. Recent literature has indicated that it is important to develop rehabilitation programmes that are based on areas of needs that are identified by the participants. To assist in the design of a group programme, a qualitative (focus group) investigation of the perceptions of young males concerning male roles and identity in today’s society was conducted. The participants were six young males with psychotic disorders who had been referred to an Australian regional rehabilitation service to address poor social functioning and social isolation. Three main themes emerged from the focus groups. These were role models, concept of what is a man, and societal expectations. The findings were used to develop a group programme called Kick’n’On.

Kick'n'on: The design and evaluation of a group programme for young males with psychotic disorders

Young men with psychotic disorders have persistently poorer outcomes in social functioning when interventions aimed at arresting social isolation are not implemented. Recent literature has indicated that it is important to develop rehabilitation programmes that are based on areas of needs that are identified by the participants. To assist in the design of a group programme, a qualitative (focus group) investigation of the perceptions of young males concerning male roles and identity in today’s society was conducted. The participants were six young males with psychotic disorders who had been referred to an Australian regional rehabilitation service to address poor social functioning and social isolation. Three main themes emerged from the focus groups. These were role models, concept of what is a man, and societal expectations. The findings were used to develop a group programme called Kick’n’On.

Classifying client goals in community-based ABI rehabilitation: a taxonomy for profiling service delivery and conceptualizing outcomes

Purpose: To develop, confirm and trial a framework for analysing the content of goals set within community-based rehabilitation. This framework (taxonomy) is proposed as a tool to assist in service evaluation and outcome exploration. Method: Qualitative thematic analysis and categorization of 1765 rehabilitation goal statements in a four phase process of synthesis, refinement, verification and application. Results: A taxonomy of goal content was developed comprising 21 categories within five domains, utilizing 125 descriptors. The taxonomy demonstrated good inter-rater consistency and was able to discriminate between similar but related data sets comprising goal statements. Conclusion: Structured analysis of the content of goal setting (particularly in community rehabilitation) utilizing a framework such as the proposed taxonomy has considerable potential as a 'window' into service delivery to broaden the parameters of existing service evaluation and to more clearly link outcome exploration to intervention.

Patterns of community integration 2-5 years post-discharge from brain injury rehabilitation

Outcome after traumatic brain injury (TBI) is characterized by a high degree of variability which has often been difficult to capture in traditional outcome studies. The purpose of this study was to describe patterns of community integration 2-5 years after TBI. Participants were 208 patients admitted to a Brain Injury Rehabilitation Unit between 1991-1995 in Brisbane, Australia. The design comprised retrospective data collection and questionnaire follow-up by mail. Mean follow-up was 3.5 years. Demographic, injury severity and functional status variables were retrieved from hospital records. Community integration was assessed using the Community Integration Questionnaire (CIQ), and vocational status measured by a self administered questionnaire. Data was analysed using cluster analysis which divided the data into meaningful subsets. Based on the CIQ subscale scores of home, social and productive integration, a three cluster solution was selected, with groups labelled as working (n = 78), balanced (n = 46) and poorly integrated (n = 84). Although 38% of the sample returned to a high level of productive activity and 22% achieved a balanced lifestyle, overall community integration was poor for the remainder. This poorly integrated group had more severe injury characterized by longer periods of acute care and post-traumatic amnesia (PTA) and greater functional disability on discharge. These findings have implications for service delivery prior to and during the process of reintegration after brain injury.

The template: A cooperative approach to evaluating community rehabilitation services

This article describes a workshop and consultation process utilized by four community rehabilitation services and other stakeholders. This process led to the development of an evaluation Template upon which to plan a service evaluation. The Template comprises a number of guiding questions within three broad domains. These are, the people domain (pertaining to the client, their disability, their family and service context), the program domain (pertaining to the service and its activities), and the perspective domain (pertaining to the broader social and community context). It is suggested that the Template, the process by which it was developed, and the guidelines for its use will have relevance to rehabilitation managers, administrators, and others involved in evaluation of community rehabilitation services.