New Directions in Occupational Therapy: Adolescent Mental Health

Transcription

1 New Directions in Occupational Therapy: Adolescent Mental Health Amy Marshall, MS, OTR/L Doris Pierce, PhD, OTR/L, FAOTA KOTA 2005 Conference Paducah, Kentucky

2 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

3 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

4 Kentucky s Demographics

5 Kentucky Rates 42 nd among states on child well-being (KYA, 2005) 23% of 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)

6 Disproportionate Representation Kentucky 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%

7 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).

8 To serve 98,146 students with special needs, there were only 159 OTs in (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

9 Students with an emotional disturbance have a dropout rate of 51% (US Department of Education, 2001)

10 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)

11 PRISYM Providing 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

12 Purpose To train occupational therapy, psychology, and social work students to work with rural youth with mental health needs

13 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.

14 Kentucky Department of Mental Health and Mental Retardation Service Regions

15 Kentucky River Community Care & Cumberland River Comprehensive Care Both regions provide communitybased 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

16 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

17 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

18 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

19 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

20 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

21 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.

22 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).

23 Occupation Based Intervention

24 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

25 Balancing Collaboration & Control Liberation Restrictive settings leads to boredom Giving choices Engaging Collaborative and continuous goal-setting Structure Adult in charge Clear rules Control over materials Building routines Choices within structure

26 Liberating Structures Challenging but successful Maximizing self-direction Therapist takes risks Chaotic-- but never boring!

27 Palette Program Based on 3 years of action research (Pierce, Fehringer, Marshall, & Cunningham, 2003).

28 Occupational Palette Prevocational Skills Independent Living Healthy Leisure Underlying areas Competence Identity Social communication

29 Prevocational Skills

30 Independent Living Skills

31 Healthy Leisure

32 Discussion & Questions References available upon request