New Directions in Occupational Therapy:

Adolescent Mental Health

Amy Marshall, MS, OTR/L

Doris Pierce, PhD, OTR/L, FAOTA

KOTA 2005 Conference

Paducah, Kentucky

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

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

Kentucky’s Demographics

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)

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%

“Warehousing children in juvenile

detention centers when they should

be getting mental health treatment is

a no-win situation…. We’ve got to get

kids the help they need, so we can

keep them out of jail” (Bazelton

Center for Mental Health Law, 2004).

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

Students with an emotional

disturbance have a dropout rate of

51% (US Department of Education,

2001)

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)

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

Purpose

To train occupational therapy,

psychology, and social work students

to work with rural youth with mental

health needs

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.

Kentucky Department of Mental Health and Mental Retardation

Service Regions

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

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

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

PRISYM Evaluation

Action Research: Cycle will be used

for continual improvement of

PRISYM’s effectiveness

Outcomes Tracking Plan: Initiate,

track, and complete steps of

traditional evaluation plan

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

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

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 one’s ability to undertake activities that one enjoys. This is interpreted as boredom.”

“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).

Occupation Based Intervention

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

Balancing Collaboration & Control

LiberationRestrictive settings leads to boredom

Giving choices

Engaging

Collaborative and continuous goal-setting

StructureAdult in charge

Clear rules

Control over materials

Building routines

“Choices within structure”

Liberating Structures

Challenging but successful

Maximizing self-direction

Therapist takes risks

Chaotic-- but never boring!

Palette Program

Based on 3 years of action research

(Pierce, Fehringer, Marshall, &

Cunningham, 2003).

Occupational Palette

Prevocational Skills

Independent Living

Healthy Leisure

Underlying areas

Competence

Identity

Social

communication

Prevocational Skills

Independent Living Skills

Healthy Leisure

Discussion & Questions

References

available upon

request